From the Guidelines
Aspirin therapy should be considered for adults aged 50-59 years who are at increased risk for cardiovascular disease (CVD) and have no increased risk for bleeding, as the net benefit in life-years and QALYs gained from aspirin use is moderate in this age group. For primary prevention, aspirin (typically 81 mg daily) may be considered in adults aged 50-59 years who have a 10% or greater 10-year CVD risk, after discussing with their healthcare provider 1. The decision to start aspirin should always be individualized based on the patient's specific cardiovascular risk factors, bleeding risk, and overall health status.
- Key considerations include:
- The patient's 10-year CVD risk, with a threshold of 10% or greater for consideration of aspirin therapy
- The patient's bleeding risk, with caution advised in those with increased risk of gastrointestinal or intracranial hemorrhage
- The patient's overall health status, including life expectancy and willingness to take low-dose aspirin daily for at least 10 years
- The benefit of aspirin stems from its antiplatelet effects, which reduce clot formation by inhibiting thromboxane A2 production, but this same mechanism increases bleeding risk, particularly gastrointestinal and intracranial hemorrhage, which becomes more pronounced with advancing age 1.
- For adults 60 years and older, routine aspirin use for primary prevention is not recommended due to increased bleeding risks that may outweigh cardiovascular benefits, unless the patient has a high CVD risk and is willing to take low-dose aspirin daily for at least 10 years 1.
- For secondary prevention (in patients who have already had a heart attack, stroke, or established cardiovascular disease), aspirin therapy is typically recommended regardless of age, unless contraindicated 1.
From the FDA Drug Label
adults and children 12 years and over: take 4 to 8 tablets every 4 hours not to exceed 48 tablets in 24 hours unless directed by a doctor The recommended age to start patients on aspirin is 12 years and over 2.
From the Research
Aspirin Use for Primary Prevention
- The optimal age to start patients on aspirin for primary prevention is not well defined, and guidelines are inconsistent 3.
- Recent trials suggest that aspirin for primary prevention may do more harm than good for some adults, including those over 70 years of age 4.
- The role of aspirin for primary prevention of cardiovascular disease in older adults should be individualized based on patient risk factors, including risk of cardiovascular disease and likelihood of bleeding 3.
Age Considerations
- A study found that 45.4% of clinicians recommended aspirin use in a 75-year-old patient with a 10-year atherosclerotic cardiovascular disease risk of 25% 4.
- Guidelines recommend against routine use of aspirin in patients over 70 years of age 4.
- There is no specific age recommendation for starting aspirin therapy, and the decision should be based on individual patient risk factors 3.
Combination Therapy
- The combination of aspirin and clopidogrel has been shown to reduce the risk of myocardial infarction and ischemic stroke, but increases the risk of major and minor bleeding 5.
- Clopidogrel should be considered as a replacement for aspirin in patients who are allergic to aspirin, cannot tolerate aspirin, or are at very high absolute risk of a serious vascular event 6.
- The combination of clopidogrel and aspirin should be considered in patients with non-ST-segment elevation acute coronary syndrome or undergoing percutaneous coronary intervention 6.