Appraising the contemporary role of aspirin for primary and secondary prevention of atherosclerotic cardiovascular events. (2nd December 2021)

• Record Type: Journal Article
• Authors: Calderone, Dario; Ingala, Salvatore; Mauro, Maria Sara; Angiolillo, Dominick J.; Capodanno, Davide
• Is Part Of: Expert review of cardiovascular therapy. Volume 19:Number 12(2021)
• Page Start: 1097
• Page End: 1117
• Publication Date: 2021-12-02
• Subjects: Antiplatelet therapy -- aspirin -- aspirin-free strategies -- cardiovascular disease -- primary prevention -- secondary prevention; Cardiovascular agents -- Research -- Periodicals; 616.12061
• DOI: 10.1080/14779072.2021.2020100
• Languages: English
• ISSNs: 1477-9072

Abstract

ABSTRACT: Introduction: Although the role of aspirin for primary prevention of atherosclerotic cardiovascular disease (ASCVD) has been disputed, its use in secondary ASCVD prevention is well established. Recent trials of primary prevention do not suggest a significant net benefit with aspirin, whereas accruing evidence supports adopting aspirin-free strategies in the context of potent P2Y12 inhibition for the secondary prevention of selected patients undergoing percutaneous coronary intervention. Areas covered: This updated review aims at summarizing and appraising the pharmacological characteristics and the contemporary role of aspirin for the primary and secondary prevention of ASCVD. Expert opinion: Recent trials and metanalyses in the context of primary prevention highlighted a modest reduction in ischemic events with aspirin use, counterbalanced by a significant increase in bleeding events. However, ongoing studies on cancer prevention could modify the current paradigm of the unfavorable benefit-risk ratio of aspirin in patients with no overt ASCVD. Conversely, aspirin use is crucial for secondary ASCVD prevention, both in chronic and acute coronary syndromes. Nevertheless, after a brief period of dual antiplatelet therapy, patients at high bleeding risk may benefit from discontinuation of aspirin if a P2Y12 inhibitor is used, hence reducing the bleeding risk with no rebound in thrombotic events.