CompletedPhase IVInterventional

ATTACK: Aspirin to prevent a first heart attack or stroke in people with chronic kidney disease

Chronic kidney disease (CKD) means your kidneys do not work as well as they should. It affects around one in eight adults in the UK and raises the chance of heart attacks and strokes. Low-dose aspirin thins the blood to help prevent clots, but it can also cause stomach irritation and bleeding. While doctors know aspirin helps people who have already suffered a heart attack or stroke, we do not yet know if it helps prevent a first one in people with kidney disease. The ATTACK trial is testing whether taking 75mg of aspirin every day is safe and effective for people with CKD. Half of the participants take daily aspirin alongside their usual medicines, while the other half continue with their normal care alone. Researchers track everyone's health through NHS records and a short yearly survey, without needing any extra clinic visits.

At a glance

Status

Completed

Phase

Phase IV

Sponsor

University of Southampton

Enrolment target

25,210

Start

22 Oct 2018

Estimated completion

21 Dec 2023

Chronic kidney disease (Stages 1-4)

What is this study about?

Chronic kidney disease, or CKD, is a common condition where the kidneys do not filter waste from the blood as effectively as they should. In the UK, it affects roughly one in eight adults, particularly older people and those with diabetes or high blood pressure. Having kidney disease also doubles the chance of developing heart problems or having a stroke, and this risk climbs higher as kidney health declines.

Heart attacks and strokes are usually triggered by tiny blood clots blocking blood flow. Aspirin works by thinning the blood, which stops these clots from forming. However, thinning the blood also means wounds and stomach linings bleed more easily. While aspirin is routinely used for patients who have already had a heart attack, doctors do not routinely recommend it to prevent a first event because the bleeding risks can sometimes outweigh the benefits.

Because people with kidney disease have a much higher risk of heart disease, taking aspirin could provide major protection. On the other hand, kidney disease itself can also raise the risk of bleeding. The ATTACK study was set up across UK universities to find a clear, reliable answer: does daily low-dose aspirin do more good than harm for people with kidney disease? The findings could guide future NHS treatment and protect thousands of patients.

Key takeaways

The ATTACK trial tests whether daily low-dose aspirin safely prevents a first heart attack or stroke in people with kidney disease.
Participants are randomly chosen to take 75mg aspirin daily or continue their normal care alone.
There are no extra hospital appointments or clinic visits needed to take part.
Your health is monitored safely through your existing GP and NHS hospital records, plus an annual survey.
Taking part is voluntary, and you can leave the study at any time without your care changing.

Who may be eligible?

This trial is open to adults aged 18 and over who have been diagnosed with chronic kidney disease (stages 1 to 4). Doctors usually identify this through routine blood tests that measure how well the kidneys filter waste, or urine tests that look for small amounts of protein.

To be suitable, participants must be able to understand the study details and agree to take part. Because the goal is to prevent a first heart attack or stroke, the study is aimed at people who are not already taking daily blood-thinning medicine for prior cardiovascular problems.

You must also be happy for the research team to review your NHS health records and contact you occasionally with brief questions about your general health.

Could this study suit you?

Answer these quick questions to see if you may be eligible. This is a guide only — the research team makes the final call.

I am aged 18 or over.
I have been diagnosed with chronic kidney disease (stages 1 to 4).
I have had blood or urine tests showing reduced kidney function or protein in my urine.
I have not had a previous heart attack or stroke that requires daily aspirin.
I am happy for researchers to check my NHS medical records and answer a yearly health survey.

Answer every question to see your result.

What does participation involve?

If you decide to join the study, a computer will place you into one of two groups by chance. One group will take a low-dose aspirin tablet (75mg) once a day along with their regular medicines. The other group will simply carry on taking their usual prescribed medicines without aspirin. Both groups are equally important to the research.

Taking part is designed to fit easily around your everyday routine. You will not need to attend extra clinic visits or travel to hospital appointments. Instead, the study team will track your health through your routine GP and hospital electronic records. You will also be asked to fill in a simple health questionnaire once a year. The trial is scheduled to follow participants until September 2025.

Potential risks and benefits

Taking part might not help your health directly, but your participation will provide vital evidence to help improve kidney care across the NHS. Low-dose aspirin is a widely used medicine, but it can cause indigestion, heartburn, or stomach irritation. It also raises the chance of bleeding; studies suggest about one extra serious stomach bleed occurs per 500 people treated each year, while bleeding in the brain is very rare (around 1 to 2 in every 10,000 people). Joining is completely voluntary, and you are free to stop taking part at any time without your regular NHS care being affected.

Locations (2)

University of Southampton
Approximate
Southampton, England
University of Nottingham
Approximate
Nottingham, England

Common questions

Do I need to attend extra hospital visits for this trial?

No. The trial is designed so you do not have to make extra trips. The team monitors your health through your regular NHS records and sends a simple questionnaire once a year.

Can I choose whether I take the aspirin?

No. A computer assigns you to either the aspirin group or the usual-care group at random. This makes sure the results are fair and scientifically reliable.

What happens if I get an upset stomach or side effects?

If you experience any unpleasant symptoms such as indigestion or unusual bruising, you should contact your GP or the study team straight away. You can stop taking the study tablets at any point.

Will taking part cost me anything?

No. Taking part is free, and any trial medication required will be provided to you.

What happens if my doctor decides I need aspirin for another reason?

Your normal medical care always comes first. If your GP or specialist feels you need aspirin or another blood thinner for your health, you will be able to take it safely as advised.

How to find out more

. ATTACK study team

attack@nottingham.ac.uk +44 (0)1158231451 Official trial record

Always speak to your GP or specialist before deciding to take part in a study.