Why we should not skip aspirin in cardiovascular prevention

Area of Science:

• Cardiology
• Pharmacology
• Vascular Medicine

Background:

• Aspirin has been a first-line antiplatelet agent for over 20 years in cardiovascular prevention.
• Its efficacy stems from unique COX-1 inhibition and thromboxane formation suppression.
• Aspirin is crucial in dual antiplatelet therapy for acute coronary syndromes and percutaneous coronary interventions.

Purpose of the Study:

• To evaluate the current role of aspirin in cardiovascular prevention in light of new oral anticoagulants (NOACs).
• To discuss the necessity of dual antiplatelet therapy, including aspirin, versus alternative antiplatelet agents.
• To highlight the need for further research on aspirin's chemopreventive role, particularly in high-risk populations.

Main Methods:

• Review of existing clinical data and pharmacological evidence on aspirin's antiplatelet effects.
• Analysis of the role of aspirin in combination therapies (dual antiplatelet therapy) and monotherapy.
• Assessment of the benefit/risk ratio of aspirin compared to newer anticoagulants and antiplatelet agents.

Main Results:

• Aspirin's unique mechanism and reliable efficacy support its continued use in cardiovascular prevention.
• Current data are insufficient to recommend skipping aspirin in favor of other oral antiplatelet agents or NOACs.
• The benefit/risk ratio, particularly concerning bleeding, remains uncertain for alternative strategies.

Conclusions:

• Aspirin's established role in cardiovascular prevention is supported by its unique pharmacological profile.
• Further research is essential to clarify the optimal use of aspirin and other antiplatelet agents alongside NOACs.
• Investigating aspirin's chemopreventive potential in high-risk groups like diabetics and those with venous thromboembolism is a priority.