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Aspirin--issues in daily practice: an update.

Roy Beigel1, Shlomi Matetzky, Paul Fefer

  • 1Department of Medicine E, Sheba Medical Center, Tel Hashomer, Israel. beigelr@post.tau.ac.il

The Israel Medical Association Journal : IMAJ
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Summary

Aspirin is effective for secondary cardiovascular disease prevention, but primary prevention benefits are unclear. High doses offer no added effect, and risks like bleeding increase with dosage, emphasizing careful patient compliance.

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Area of Science:

  • Cardiology
  • Pharmacology
  • Preventive Medicine

Background:

  • Cardiovascular disease (CVD) prevention strategies are crucial.
  • Aspirin is widely used, but its optimal role and risks require clarification.
  • Aspirin resistance and adverse effects are significant clinical concerns.

Purpose of the Study:

  • To summarize current knowledge on primary and secondary CVD prevention with aspirin.
  • To review aspirin's role in atrial fibrillation (AF) and combined therapies.
  • To highlight aspirin resistance, adverse effects, and patient compliance.

Main Methods:

  • Literature review and synthesis of current evidence.
  • Analysis of guidelines for aspirin use in specific patient populations.
  • Discussion of therapeutic dosages and risk-benefit profiles.

Main Results:

  • Aspirin is well-established for secondary prevention in high-risk populations and acute coronary syndromes (ACS).
  • Primary prevention benefits are limited to select moderate-to-high-risk male patients.
  • Doses of 75-150 mg/day are effective; higher doses show no additional benefit.
  • Adverse events, particularly bleeding, increase with dose and prolonged use in low-risk groups.
  • Patient compliance is critical for treatment success.

Conclusions:

  • Aspirin is essential for secondary CVD prevention but requires careful consideration for primary prevention.
  • Optimal dosing (75-150 mg/day) balances efficacy and safety.
  • Managing adverse effects and ensuring patient compliance are paramount.
  • Further research into reliable aspirin resistance testing is needed.