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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
Insights
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.
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.
Abstract:
We have summarized current knowledge regarding primary and secondary prevention of cardiovasular disease, with an emphasis on aspirin resistance and adverse effects. The use of combined therapy of aspirin and warfarin was discussed and the role of aspirin in patients with AF was reviewed according to the latest guidelines /Table 3/. The issue of primary prevention remains only partially resolved, though it would seem that male patients at moderate to high risk for CVD may benefit. On the other hand, the role of aspirin for secondary prevention in high risk populations and in ACS is well established. A dose of 75-150 mg/day has been validated in numerous studies with higher doses showing no additional effects. Aspirin should not be regarded as an innocent drug, since prolonged use in low risk populations carries the risk of serious adverse events, primarily bleeding. Adverse events seem to increase linearly with increased doses. Patient compliance remains a major issue regarding treatment failure and achieving clinical benefit and should be stressed at every physician-patient encounter. Further research is required to develop testing methods that are reliable, standardized and accurate for aspirin resistance, and currently such testing is not recommended. Withdrawal of aspirin treatment should not be considered an innocent act as it may cause susceptibility to atherothrombotic events.
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