From the Guidelines
Arena and ASA are two distinct entities, with ASA being a medication used to reduce pain, fever, and inflammation, commonly prescribed at doses of 81mg for cardiovascular protection. The most recent and highest quality study on this topic is from 2012, which suggests that perioperative continuation of ASA may benefit patients with coronary artery or other cardiovascular disease who are at moderate to high risk for perioperative adverse cardiovascular events 1. Some key points to consider when using ASA include:
- The initial dose of ASA should be between 162 and 325 mg, with a maintenance dose of 75 to 162 mg preferred for long-term use 1
- ASA should be initiated immediately in patients with suspected acute coronary syndrome (ACS) unless there are contraindications such as a known aspirin allergy or active gastrointestinal hemorrhage 1
- The use of low-dose ASA for cardioprophylaxis is associated with a 2- to 4-fold increase in upper gastrointestinal bleeding risk, and gastroprotection should be prescribed for patients at risk of adverse events 1
- The combined use of nonsteroidal anti-inflammatory drugs (NSAIDs) and ASA increases the risk of gastrointestinal bleeding, and the use of a cyclooxygenase-2 (COX-2) inhibitor plus ASA may be safer than a nonselective NSAID plus ASA 1. Overall, the use of ASA should be individualized based on the patient's risk factors and medical history, with careful consideration of the potential benefits and risks.
From the Research
Aspirin (ASA) Overview
- Aspirin (ASA) is a widely prescribed medication for various uses, including cardiovascular disease prevention, pain relief, and fever reduction 2.
- It is an essential component of dual antiplatelet therapy and dual pathway inhibition, with ongoing research on optimal dosing frequency and safer formulations 2.
Aspirin for Primary Prevention of Cardiovascular Disease
- The role of ASA in primary prevention of cardiovascular disease has been controversial, with historical trials showing modest benefits and increased bleeding risks 3.
- Recent trials have led to a downgrade in recommendations for ASA use in primary prevention, citing neutral or harmful effects in patients without overt cardiovascular disease 3.
- A platelet-guided approach has been proposed to identify individuals who may benefit from prophylactic ASA therapy, using biomarkers such as platelet activity and transcriptomics 4.
Aspirin Formulations and Delivery
- Extended-release ASA formulations have been developed to provide 24-hour anti-thrombotic coverage with once-daily dosing, minimizing systemic ASA absorption and reducing bleeding risks 5.
- Traditional ASA formulations may not provide adequate anti-thrombotic benefits over a 24-hour period, especially in high-risk patients 5.
Antiplatelet Therapy and Cardiovascular Disease
- Antiplatelet agents, including ASA, are well-established treatments for arteriosclerosis and cardiovascular disease, with dual antiplatelet therapy indicated for high-risk patients 6.
- The efficacy of antiplatelet therapy is well established, but aggressive therapy is associated with an increased bleeding risk, highlighting the need for personalized approaches 6.