From the Guidelines
The most appropriate dose of aspirin for a person with uncontrolled diabetes is 81 mg, as there is no clear evidence to support the use of 100 mg over 81 mg in this population. Both 81 mg and 100 mg are considered low-dose aspirin regimens used for cardiovascular protection in high-risk individuals, including those with diabetes. The slight difference in dosage reflects regional preferences rather than meaningful clinical differences in efficacy or safety.
Key Considerations
- For patients with diabetes, aspirin is typically recommended if they have additional cardiovascular risk factors or established cardiovascular disease.
- The control status of diabetes itself doesn't determine which specific low-dose aspirin amount is preferable.
- More important factors include the patient's overall cardiovascular risk profile, history of bleeding, concurrent medications, and individual response to therapy.
- Patients with uncontrolled diabetes should focus primarily on improving glucose control through appropriate diabetes management while following their doctor's recommendation regarding aspirin therapy.
Evidence Summary
- A recent study published in 2025 1 found that there were no significant differences in cardiovascular events or major bleeding between individuals assigned to 81 mg and those assigned to 325 mg of aspirin daily.
- The same study suggested that 75–162 mg/day is optimal for aspirin dosing in patients with diabetes.
- Another study published in 2018 1 also suggested that using the lowest possible dose of aspirin may help reduce adverse effects.
- Overall, the evidence suggests that the choice between 81 mg and 100 mg of aspirin should be based on individual patient factors, rather than a specific dose being recommended for all patients with uncontrolled diabetes.
From the Research
Aspirin Dosage for Uncontrolled Diabetes
- The decision to use 100 mg instead of 81 mg of low-dose aspirin in a person with uncontrolled diabetes should be based on individual risk factors and medical history 2, 3.
- Studies have shown that aspirin can be beneficial in reducing the risk of cardiovascular events in patients with diabetes, but the optimal dosage is not clearly established 4, 5.
- A meta-analysis found that aspirin use in patients with diabetes was associated with a significant reduction in major adverse cardiovascular events (MACE), but not with a significant reduction in all-cause mortality or bleeding events 4.
- The COMPASS trial found that the combination of rivaroxaban and aspirin (100 mg daily) was effective in reducing major vascular events in patients with diabetes and established coronary artery disease or peripheral artery disease 5.
- Another study found that aspirin and clopidogrel had similar risks of incident diabetes, cardiovascular events, and bleeding events among patients with atherosclerotic cardiovascular diseases 6.
Considerations for Aspirin Dosage
- The choice of aspirin dosage should take into account the individual patient's risk factors, such as the presence of cardiovascular disease, kidney disease, or bleeding disorders 2, 3.
- Patients with uncontrolled diabetes may require closer monitoring of their blood sugar levels and kidney function when taking aspirin, as aspirin can affect blood sugar control and kidney function 4, 5.
- The use of aspirin in combination with other antiplatelet or anticoagulant agents should be carefully considered, as this may increase the risk of bleeding complications 3, 5.