From the Guidelines
Aspirin should be used with caution in primary prevention of cardiovascular disease, as the benefits in reducing myocardial infarction (MI) and stroke may be outweighed by the increased risk of major extracranial bleeding, particularly in low-cardiovascular-risk populations 1.
Aspirin Mechanism and Uses
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, antipyretic, and antiplatelet properties, containing acetylsalicylic acid as its active ingredient. It works by inhibiting cyclooxygenase enzymes, reducing prostaglandins and thromboxanes production. Typical dosing for pain relief and fever reduction is 325-650 mg every 4-6 hours, not exceeding 4,000 mg daily. For cardiovascular protection, lower doses of 81-100 mg daily are commonly prescribed.
Benefits and Risks
The benefits of aspirin in primary prevention of cardiovascular disease include reducing the risk of MI, with a relative risk (RR) of 0.77 (95% CI, 0.69-0.86) 1. However, this benefit may be offset by the increased risk of major extracranial bleeding, with an RR of 1.54 (95% CI, 1.30-1.82) 1. The risk of bleeding varies by cardiovascular risk group, with low-risk populations experiencing 4 more bleeds per 1,000 (from 2 more to 7 more) 1.
Patient Selection and Monitoring
When considering aspirin for primary prevention, it is essential to assess the patient's cardiovascular risk using tools like the Framingham score. Patients at high risk of cardiovascular events may benefit from aspirin, while those at low risk may not. Patients should be monitored for signs of bleeding, and the decision to start aspirin should be made after consulting a healthcare provider, especially if the patient has other medical conditions or takes other medications.
Key Considerations
- Aspirin may reduce the risk of MI, but increases the risk of major extracranial bleeding 1.
- The benefits and risks of aspirin vary by cardiovascular risk group, with low-risk populations potentially experiencing more harm than benefit 1.
- Patients should be carefully selected and monitored when considering aspirin for primary prevention of cardiovascular disease.
From the FDA Drug Label
Warnings Reye's syndrome: Children and teenagers who have or are recovering from chicken pox or flu-like symptoms should not use this product, if changes in behavior with nausea and vomiting occur, consult a doctor because these symptoms could be an early sign of Reyes syndrome, a rare but serious illness Allergy alert: Aspirin may cause a severe allergic reaction which may include: hives, facial swelling, asthma(wheezing), shock Stomach bleeding warning: This product contains an NSAID, which may cause severe stomach bleeding The chance is higher if you are age 60 or olderHave had stomach ulcers or bleeding problemsTake a blood thinning (Anticogulant) or steroid drugTake other drugs containing prescription or nonprescription NSAIDs (aspirin, ibuprofen, naproxen, or others)have 3 or more alcoholic drinks every day using this product Active Ingredient (in each tablet) Aspirin 81 mg (NSAID)nonsterodial anti-inflammatory drug
- Aspirin Analysis:
- Warning and Precautions: Aspirin may cause severe allergic reactions, stomach bleeding, and Reye's syndrome in children and teenagers.
- Key Considerations: The risk of stomach bleeding is higher in individuals aged 60 or older, those with stomach ulcers or bleeding problems, and those taking blood thinning or steroid drugs.
- Active Ingredient: Aspirin 81 mg, a nonsteroidal anti-inflammatory drug (NSAID) 2, 2. Aspirin should be used with caution due to the potential risks and side effects.
From the Research
Aspirin Analysis
- Aspirin has been widely accepted for the secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in all patient populations, as the benefits linked to the reduction of clinical events outweigh the risk of major bleeding 3.
- However, the overall efficacy and safety of aspirin in primary ASCVD prevention remains debatable, despite being used for this purpose for decades 3, 4.
- Recent large contemporary randomized controlled trials evaluating the role of aspirin in various primary prevention populations have brought into question the net clinical benefit of aspirin 3.
- The use of aspirin in patients with estimated intermediate to high ASCVD risk but without overt ASCVD has already been removed from most international guidelines 3.
- A more individualized approach based on the best possible estimated ratio between the potential health benefits from fewer atherothrombotic events and harms because of potential increases in major bleeding is warranted in clinical practice 3, 5.
- Clinicians should assess the risk of major adverse cardiovascular events (MACE) and base decisions on such stratification, considering the risk of bleeding and patient preferences 5.
- Aspirin therapy may still be beneficial for primary prevention in patients at high risk of MACE who do not have a prohibitive risk of bleeding, and in the majority of cases after initiation of properly titrated statin therapy 5.
- The risks of aspirin use, particularly bleeding, should be carefully considered, particularly in people with diabetes, in women, and in the elderly 6.
- Proton pump inhibitor use has been associated with an increased risk of adverse cardiovascular events in aspirin-treated patients with first-time myocardial infarction 7.
Key Findings
- Aspirin is effective for secondary prevention of ASCVD, but its role in primary prevention is debated 3, 4.
- Individualized approach to aspirin use in primary prevention is recommended, considering the risk of MACE and bleeding 3, 5.
- Aspirin may still be beneficial for primary prevention in high-risk patients without prohibitive bleeding risk 5.
- Risks of aspirin use, particularly bleeding, should be carefully considered in certain populations 6.
- Proton pump inhibitor use may increase the risk of adverse cardiovascular events in aspirin-treated patients 7.