Can Patients on 80 mg Aspirin Be Switched to 100 mg?
Yes, patients taking 80 mg aspirin can safely be switched to 100 mg aspirin, as both doses fall within the recommended maintenance range of 75-100 mg daily for cardiovascular protection. 1
Guideline-Supported Dose Range
The European Society of Cardiology (ESC) explicitly recommends a daily aspirin dose of 75-100 mg for patients treated with dual antiplatelet therapy (DAPT). 1
The American Heart Association/American College of Cardiology (AHA/ACC) guidelines recommend 81 mg (range 75-100 mg) as the standard maintenance dose for patients with acute coronary syndromes, stable ischemic heart disease, or following coronary stent placement. 1
Both 80 mg and 100 mg are within the therapeutic window that provides optimal cardiovascular protection while minimizing bleeding risk. 1
Clinical Context for the Switch
The difference between 80 mg and 100 mg aspirin is clinically insignificant:
Major clinical trials have used aspirin doses ranging from 75 mg to 325 mg, with doses in the 75-100 mg range showing equivalent efficacy for preventing major adverse cardiovascular events (MACE). 1
The 2023 ACC/AHA guidelines note that 81 mg daily meets performance measure requirements, and the writing committee opinion extends this to include the entire 75-100 mg range. 1
When used with ticagrelor specifically, the recommended aspirin maintenance dose is 81 mg daily (not exceeding 100 mg), based on post-hoc analysis from the PLATO trial showing better outcomes with lower aspirin doses. 1
Practical Switching Algorithm
For most cardiovascular indications:
- Switch directly from 80 mg to 100 mg without titration or monitoring
- No loading dose required
- Continue indefinitely unless contraindications develop 1
Special consideration - if patient is on ticagrelor:
- Maintain aspirin at ≤100 mg daily (80 mg or 81 mg preferred over 100 mg)
- Higher aspirin doses with ticagrelor may reduce efficacy 1
For patients with high bleeding risk:
- Both 80 mg and 100 mg carry similar bleeding risk
- Consider staying at 80 mg if already well-tolerated
- Add proton pump inhibitor (PPI) for gastrointestinal protection regardless of dose 1
Common Pitfalls to Avoid
Do not increase aspirin to doses >100 mg when used with P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor), as this increases bleeding without additional cardiovascular benefit. 1
Do not confuse maintenance dosing (75-100 mg daily) with loading doses (162-325 mg) used in acute coronary syndromes. 1
Avoid enteric-coated formulations for loading doses in acute settings, as non-enteric coated aspirin should be chewed for faster onset. 1