From the Guidelines
After a non-ST-elevation myocardial infarction (NSTEMI), you should typically take low-dose aspirin (81 mg) indefinitely, with the enteric-coated formulation generally preferred over chewable for long-term use. The enteric-coated version reduces gastrointestinal side effects like stomach irritation and bleeding, making it more suitable for indefinite use [ 1 ]. However, during the acute phase of a heart attack, chewable aspirin is preferred because it works faster. For ongoing prevention after NSTEMI, the enteric-coated version is usually recommended unless your doctor specifically advises otherwise. This long-term aspirin therapy helps prevent future cardiovascular events by inhibiting platelet aggregation, reducing the risk of blood clots that could cause another heart attack [ 1 ]. You should take this medication with food to further minimize stomach irritation. It's essential to continue this therapy unless directed otherwise by your healthcare provider, as premature discontinuation increases your risk of another cardiac event [ 1 ]. If you experience side effects like unusual bleeding or stomach pain, consult your doctor rather than stopping the medication on your own.
Some key points to consider:
- Aspirin should be continued indefinitely after a MI, with a maintenance dose of 81 mg daily [ 1 ]
- The enteric-coated formulation is preferred for long-term use due to reduced gastrointestinal side effects [ 1 ]
- High-dose aspirin is associated with increased bleeding risk without improved outcomes [ 1 ]
- Aspirin inhibits the formation of thromboxane A2, a potent stimulator of platelet aggregation, and is the first-line therapy for AMI [ 1 ]
It's crucial to follow your healthcare provider's guidance on aspirin therapy, as they can provide personalized recommendations based on your specific condition and medical history [ 1 ].
From the Research
Treatment Following Non-ST-Elevation Myocardial Infarction (NSTEMI)
- Patients with NSTEMI are at high risk for atherothrombotic recurrences, and dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is recommended for secondary prevention 2.
- Aspirin is recommended for all patients with a suspected acute coronary syndrome (ACS) unless contraindicated, and a second antiplatelet agent is also recommended for most patients 3.
- Clinical guidelines recommend an invasive strategy with cardiac catheterization, revascularization when clinically appropriate, and initiation of dual antiplatelet therapy regardless of whether the patient receives revascularization 4.
Long-Term Treatment
- Aspirin or clopidogrel, beta blockers, and angiotensin-converting enzyme (ACE) inhibitors should be given indefinitely unless contraindications exist to the use of these drugs 5.
- Patients should be placed on antiplatelet agents, a statin, a beta-blocker, and renin-angiotensin-aldosterone system blockers after myocardial infarction (MI) 6.
- The specific dosage of aspirin, such as 81 mg, enteric coated or chewable, is not explicitly mentioned in the provided studies, but aspirin is generally recommended as part of long-term treatment 5, 6.