Aspirin at 120: Retiring, recombining, or repurposing?

Area of Science:

• Cardiology
• Oncology
• Pharmacology

Background:

• Recent trends show significant shifts in low-dose aspirin utilization over the past two decades.
• These changes include early discontinuation from dual antiplatelet therapy and triple antithrombotic therapy post-acute coronary syndrome or percutaneous coronary intervention.
• A growing interest in aspirin's potential chemopreventive effects against cancers, particularly gastrointestinal cancers, is also evident.

Purpose of the Study:

• To review the mechanistic rationale behind current aspirin usage trends.
• To discuss clinical trial designs and findings related to novel aspirin treatments and applications.
• To report on relevant outcomes from the International Society on Thrombosis and Haemostasis (ISTH) Congress.

Main Methods:

• Literature review of trends in aspirin usage.
• Analysis of clinical trial data on novel aspirin applications.
• Synthesis of findings presented at the ISTH Congress.

Main Results:

• Observed trends include 'dropping' (early discontinuation), 'combinatorial' (long-term use with P2Y12 inhibitors or DOACs), and 'repurposing' (cancer chemoprevention).
• Mechanistic insights and trial data support these evolving therapeutic strategies.
• ISTH Congress highlighted new research on aspirin's role in cardiovascular and oncologic care.

Conclusions:

• Aspirin's role in cardiovascular disease management is evolving, with a move towards more tailored combination therapies.
• The repurposing of aspirin for cancer chemoprevention represents a significant new frontier in its therapeutic application.
• Ongoing research and congress findings underscore the dynamic nature of aspirin's clinical utility.