Polzin A, Dannenberg L, Helten C, et al. - In this study, excess mortality was conferred by aspirin and dipyrone co‐medication, and this was partially driven by ischemic events (myocardial infarction and stroke), which happened more often in co‐medicated patients as well. Therefore, exercising caution is recommended for dipyrone use in aspirin‐treated patients for secondary prevention.

• A health insurance database in Germany comprising 9.2 million patients was used to perform this observational, nationwide analysis including all patients who suffered a cardiovascular event in 2014 and subsequently received secondary prevention with aspirin and observed for 36 months.

• A total of 26,200 patients received permanent aspirin‐alone medication, and 5,946 received aspirin–dipyrone co‐medication.

• Aspirin–dipyrone co‐medicated patients, in the inverse probability of treatment weighted sample, exhibited excess mortality (15.6% in aspirin‐only group vs 24.4% in the co‐medicated group, hazard ratio [HR], 1.66).

• In addition, increases in myocardial infarction and stroke/transient ischemic attack was evident (myocardial infarction: 5.2% vs 5.9% in aspirin‐only and co‐medicated groups, respectively; HR, 1.18, relative risk [RR], 1.14, stroke/transient ischemic attack, 7.3% vs 8.5% in aspirin‐only and co‐medicated groups, respectively; HR, 1.22, RR, 1.17).