[Aspirin: recent advances in cardiovascular prevention]

More than a century after being launched onto the market, aspirin still remains a fascinating drug, both for its demonstrated antalgic, antipyretic, antiinflammatory and antithrombotic properties and, also, for newer, yet conjectural, applications mentioned in recent publications. The role of aspirin, as an irreversible COX-1 inhibitor and antiplatelet agent, is well elucidated and established. Our purpose is to review the value of aspirin for primary and secondary prevention of ischemic cardiovascular events. The clinician constantly has to manage a trade off between the protective effects of aspirin and its possible hemorrhagic, notably gastrointestinal, side-effects. The Task Force of the ESC recommends the use of doses no higher than 75-100 mg/d. New antiplatelet agents (thienopyridin derivatives), which have a totally different mode of action, have been introduced and were compared with aspirin. Although clopidogrel may be slightly superior to the latter, according to the European experts: "the size of any additional benefit is statistically uncertain and the drug has not been granted a claim, of superiority". Economical considerations reinforce this view. Clopidogrel is undoubtedly a good alternative when aspirin is contra-indicated, poorly tolerated, or not efficacious. Resistance to aspirin and resistance to clopidogrel have been described. In some high-risk patients, the combined use of aspirin and clopidogrel is deemed justified.