What is the medical scenario in which low-dose aspirin (acetylsalicylic acid), 81 milligrams, is appropriate?

From the Guidelines

Low-dose aspirin, 81 milligrams, is appropriate for patients with a history of coronary artery disease, including those with acute coronary syndrome (ACS) or those who have undergone percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).

Medical Scenarios for Low-Dose Aspirin

• Patients with ACS (NSTE-ACS or STEMI) treated with DAPT after BMS or DES implantation, where a daily aspirin dose of 81 mg (range, 75 mg to 100 mg) is recommended 1.
• Patients with NSTE-ACS without contraindications, where non–enteric-coated, chewable aspirin (162 mg to 325 mg) should be given as soon as possible after presentation, and a maintenance dose of aspirin (81 mg/d to 325 mg/d) should be continued indefinitely 1.
• Patients undergoing coronary artery bypass grafting, where aspirin should be started within 6 hours after surgery to reduce saphenous vein graft closure, with dosing regimens ranging from 100 to 325 mg daily for 1 year 1.
• Patients with symptomatic atherosclerotic peripheral artery disease of the lower extremity, where antiplatelet therapy with aspirin (75–325 mg daily) or clopidogrel (75 mg daily) should be started and continued 1.
• Patients with extracranial carotid or vertebral atherosclerosis who have had ischemic stroke or TIA, where treatment with aspirin alone (75–325 mg daily), clopidogrel alone (75 mg daily), or the combination of aspirin plus extended-release dipyridamole should be started and continued 1.

Important Considerations

• 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 is not useful for preventing a first stroke in persons at low risk or in persons with diabetes or diabetes plus asymptomatic peripheral artery disease in the absence of other established CVD 1.

From the FDA Drug Label

PRINCIPAL DISPLAY PANEL NDC 55681-403-03 *Compare to active ingredients in Bayer ®Aspirin Low Dose 81 mg Adult Low Dose Pain Reliever Aspirin Delayed Release Tablets, 81 mg Pain Reliever (NSAID) Enteric Coated 300 Tablets The medical scenario in which low-dose aspirin (acetylsalicylic acid), 81 milligrams, is appropriate is as a pain reliever for adults.

• The label specifies it is for low dose pain relief.
• It is classified as a Nonsteroidal Anti-Inflammatory Drug (NSAID). 2

From the Research

Medical Scenario for Low-Dose Aspirin

The medical scenario in which low-dose aspirin (acetylsalicylic acid), 81 milligrams, is appropriate includes:

• Primary prevention of cardiovascular disease (CVD) in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk 3
• Patients with diabetes who are at high risk for CVD-related mortality and morbidity 4
• Secondary prevention of ischemic stroke in patients with a history of stroke or transient ischemic attack (TIA) 5

Patient Selection

When selecting patients for low-dose aspirin therapy, the following factors should be considered:

• Age: 40 to 59 years for primary prevention of CVD 3
• CVD risk: 10% or greater 10-year CVD risk for primary prevention 3
• Diabetes: patients with diabetes who are at high risk for CVD-related mortality and morbidity 4
• Bleeding risk: patients who are not at increased risk for bleeding 3, 6

Dosing Considerations

The optimal dose of aspirin for primary and secondary prevention of events is uncertain, and dosing considerations should include an evaluation of a patient's individual clinical status as well as an overall cardiovascular and cerebrovascular benefit vs. risk assessment 7

• Low-dose aspirin (75-325 mg daily) is commonly used for the secondary prevention of cardiovascular and cerebrovascular events 7
• No difference in efficacy or safety was observed between ASA 81 mg and ASA 325 mg in one double-blind study 7