From the Guidelines
Aspirin is still prescribed regularly for specific medical conditions, particularly for patients with cardiovascular disease, at a low dose of 81-325 mg daily. Aspirin is commonly used as a blood thinner to prevent heart attacks and strokes in people with cardiovascular disease. It is also used for secondary prevention in patients who have already experienced a heart attack or stroke, usually at 81 mg daily for long-term therapy 1. For pain and inflammation, higher doses (325-650 mg every 4-6 hours) may be prescribed short-term. However, regular aspirin use has declined for primary prevention in healthy individuals due to bleeding risks. The medication works by inhibiting platelets from clumping together and forming clots, while also reducing inflammation by blocking certain enzymes. Before starting aspirin therapy, patients should consult with their healthcare provider as it can cause side effects including stomach irritation, ulcers, and bleeding complications 1. Taking aspirin with food and using enteric-coated formulations can help reduce gastrointestinal side effects. Some key points to consider when prescribing aspirin include:
- The recommended maintenance dose of aspirin to be used with ticagrelor is 81 mg daily 1
- High-dose (≥160 mg) versus low-dose (<160 mg) aspirin is associated with increased bleeding risk in the absence of improved outcomes 1
- Enteric-coated aspirin should be avoided initially because of its delayed and reduced absorption 1
- Aspirin should be continued indefinitely in patients with cardiovascular disease, unless contraindicated 1
From the Research
Aspirin Prescription Status
- Aspirin is still widely prescribed as an antiplatelet agent, particularly for secondary prevention of cardiovascular events 2, 3.
- However, its effectiveness in primary prevention of cardiovascular disease has been subject to controversy, with recent studies showing either no benefit or modest benefit accompanied by an increased risk of bleeding 4, 5.
- Aspirin remains the first line of antiplatelet drug for secondary prevention of cardiovascular events in patients with peripheral arterial disease (PAD), although new anti-platelet drugs may be more effective in certain cases 2.
- The use of aspirin for primary prevention of cardiovascular disease has been downgraded in current recommendations due to the lack of clear benefit and increased risk of bleeding 4, 5.
Clinical Applications
- Aspirin is commonly used in the management of thrombotic and cardiovascular disorders, including acute coronary syndromes, coronary artery bypass graft, and chronic atrial fibrillation 3, 6.
- New antiplatelet agents, such as prasugrel and ticagrelor, have shown clear benefits compared to clopidogrel for dual antiplatelet therapy, and may be used in specific settings 6.
- The combination of aspirin, clopidogrel, and low-dose rivaroxaban has been approved for secondary prevention after acute coronary syndromes in some regions 6.
Future Directions
- A platelet-guided approach to aspirin therapy has been proposed, which involves quantifying platelet activity to identify individuals at elevated cardiovascular risk due to a hyperreactive platelet phenotype 5.
- This approach may help to personalize antiplatelet therapy and optimize the benefit/risk ratio of aspirin treatment 5.