Aspirin: promise and resistance in the new millennium

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Oncology

Background:

• Aspirin, developed in the late 19th century, is the established standard for antiplatelet therapy.
• Extensive clinical trials confirm its effectiveness and safety in preventing major vascular events.
• Despite its long history, several aspects of aspirin's use remain under discussion.

Purpose of the Study:

• To review current debates and emerging opportunities for aspirin as an antiplatelet agent.
• To integrate molecular mechanisms, clinical trial data, and epidemiological findings.
• To address key issues including optimal dosage, primary prevention thresholds, gender-specific effects, aspirin resistance, and novel applications.

Main Methods:

• Review of approximately 100 randomized clinical trials.
• Analysis of epidemiological studies on aspirin's efficacy and safety.
• Integration of molecular mechanism of action data.
• Synthesis of evidence on aspirin's role in cardiovascular prophylaxis, cancer chemoprevention, and pain management.

Main Results:

• Aspirin is effective for secondary and long-term primary prevention of cardiovascular events.
• Debates persist regarding optimal dose, primary prevention risk thresholds, and gender differences.
• Aspirin resistance is a recognized phenomenon, and its chemopreventive role in colorectal cancer is gaining attention.
• Renewed interest exists in aspirin's analgesic properties for osteoarthritis patients at high cardiovascular risk.

Conclusions:

• Aspirin remains a cornerstone of antiplatelet therapy with established benefits.
• Further research is needed to optimize its use and address areas of uncertainty.
• Novel applications in cancer chemoprevention and pain management present future opportunities for this versatile drug.