To the Editor: Dr Berger and colleagues1 conducted a meta-analysis investigating aspirin for prevention of cardiovascular events in patients with peripheral arterial disease (PAD). They found that treatment with aspirin alone or with dipyridamole in patients with PAD resulted in a statistically nonsignificant decrease in cardiovascular events and a statistically significant reduction in nonfatal stroke. Although funnel plots were reportedly generated for cardiovascular events, the authors did not assess publication bias for nonfatal stroke.
In the subset of 6 randomized controlled trials of aspirin alone (including trials in which either the treatment or control group did not have any events, but excluding trials in which both groups had no events), aspirin was associated with a significant reduction in nonfatal stroke (pooled relative risk [RR], 0.64; 95% confidence interval [CI], 0.42-0.99). To assess the effect of possible publication bias, we recommend using a trim and fill adjustment.2 This is an iterative nonparametric adjustment method based on a rank-based data augmentation technique to account for asymmetry on the funnel plot.3 If the conclusion of the meta-analysis remains unchanged following adjustment for the publication bias, the results can be considered reasonably robust, excluding publication bias.4 Publication or related biases can be common within meta-analyses, and researchers should routinely check whether conclusions of systematic reviews are robust to possible nonrandom selection mechanisms.5
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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