Weighing the Anti-Ischemic Benefits and Bleeding Risks from Aspirin Therapy: a Rational Approach

Current Atherosclerosis Reports
Sagar DuganiSamia Mora

Abstract

The role of aspirin in secondary cardiovascular prevention is well understood; however, the role in primary prevention is less clear, and requires careful balancing of potential benefits with risks. Here, we summarize the evidence base on the benefits and risks of aspirin therapy, discuss clinical practice guidelines and decision support tools to assist in initiating aspirin therapy, and highlight ongoing trials that may clarify the role of aspirin in cardiovascular disease prevention. In 2016, the USPSTF released guidelines on the use of aspirin for primary prevention. Based on 11 trials (n = 118,445), aspirin significantly reduced all-cause mortality and nonfatal myocardial infarction, and in 7 trials that evaluated aspirin ≤ 100 mg/day, there was significant reduction in nonfatal stroke. The USPSTF recommends individualized use of aspirin based on factors including age, 10-year atherosclerotic cardiovascular disease risk score, and bleeding risk. Several ongoing trials are evaluating the role of aspirin in primary prevention, secondary prevention, and in combination therapy for atrial fibrillation. Evidence-based approaches to aspirin use should consider the anti-ischemic benefits and bleeding risks from aspirin. In this era...Continue Reading

References

Nov 19, 1982·Science·J A Oates
Sep 24, 2004·The New England Journal of Medicine·Alan S GoChi-yuan Hsu
Mar 9, 2005·The New England Journal of Medicine·Paul M RidkerJulie E Buring
Nov 11, 2008·JAMA : the Journal of the American Medical Association·Hisao OgawaUNKNOWN Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) Trial Investigators
Nov 20, 2008·Journal of the American College of Cardiology·Deepak L BhattUNKNOWN American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents
Apr 2, 2009·The New England Journal of Medicine·Stuart J ConnollySalim Yusuf
Jun 18, 2009·Current Opinion in Infectious Diseases·Esteban MartínezJosé M Gatell
Sep 2, 2009·Annals of Internal Medicine·Daniel E SingerAlan S Go
Mar 4, 2010·JAMA : the Journal of the American Medical Association·F Gerald R FowkesUNKNOWN Aspirin for Asymptomatic Atherosclerosis Trialists
Sep 8, 2010·The New England Journal of Medicine·Shamir R MehtaSalim Yusuf
Nov 13, 2010·Circulation Research·Matthew Spite, Charles N Serhan
Apr 20, 2011·Annals of Internal Medicine·P J DevereauxUNKNOWN POISE (PeriOperative ISchemic Evaluation) Investigators
Jun 29, 2012·Clinical Cardiology·Jonathan Grinstein, Christopher P Cannon
Sep 4, 2012·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Greer A BurkholderJames H Willig
Feb 21, 2013·Seminars in Arthritis and Rheumatism·Sara R SchoenfeldKaren H Costenbader
Jun 25, 2013·Current HIV/AIDS Reports·Virginia A Triant
Jul 12, 2013·JAMA : the Journal of the American Medical Association·Christopher J L MurrayUNKNOWN U.S. Burden of Disease Collaborators
Aug 28, 2013·The Canadian Journal of Cardiology·Jean-François TanguayUNKNOWN Canadian Cardiovascular Society
Sep 18, 2013·Circulation Journal : Official Journal of the Japanese Circulation Society·Sadanori OkadaUNKNOWN investigators for the Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD) trial
May 16, 2014·Canadian Journal of Diabetes·James A StonePeter Lin
Feb 19, 2014·Anesthesiology·Fernando BottoUNKNOWN Vascular events In noncardiac Surgery patIents cOhort evaluatioN VISION Study Investigators
Apr 1, 2014·The New England Journal of Medicine·P J DevereauxUNKNOWN POISE-2 Investigators
Aug 12, 2014·European Heart Journal·Steen D Kristensen, Juhani Knuuti
Apr 8, 2015·International Journal of Clinical Practice·A Tran-DuyC D A Stehouwer
Apr 22, 2015·Cleveland Clinic Journal of Medicine·Jeremiah P Depta, Deepak L Bhatt
Sep 27, 2015·Circulation·Gregory A RothChristopher J L Murray
Dec 24, 2015·Diabetes Care·UNKNOWN American Diabetes Association
Jan 13, 2016·Current Atherosclerosis Reports·Michael D MiedemaSalim S Virani
Mar 5, 2016·The New England Journal of Medicine·Paul S MylesUNKNOWN ATACAS Investigators of the ANZCA Clinical Trials Network
Mar 26, 2016·Journal of the American College of Cardiology·Muthiah VaduganathanUNKNOWN COGENT Investigators

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Citations

Aug 20, 2019·Nature Reviews. Disease Primers·Peter LibbyEldrin F Lewis
Mar 4, 2021·European Journal of Pharmacology·Shiyuan XieBin Yang

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