What is the role of aspirin in the treatment of coronary artery atherosclerosis?

Updated: Apr 09, 2021
  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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Previously, the risk of myocardial ischemic events in patients with ACS was shown to be reduced by means of platelet inhibition with the use of aspirin. All patients with documented CAD had been recommended to be treated with daily aspirin, unless contraindicated. More recent trials indicate that aspirin has no role in primary prevention of cardiovascular events. Some studies found no effect of aspirin on cardiovascular risk reduction in long-term primary prevention, whereas others demonstrated the risks of aspirin use outweighed its benefits. [69, 70, 71, 72]

In 2018, three large trials released their findings regarding the use of aspirin for primary prevention in different patient populations. The spirin to educe isk of nitial ascular vents (ARRIVE) trial (N = 12,546) showed aspirin had no effect on all-cause death or cardiovascular outcome in patients with moderate cardiovascular risk. [69] The A S tudy of ardiovascular vents in iabetes (ASCEND) (N = 15,480) found a modest benefit in reducing cardiovascular in patients with diabetes, but there was a relatively significant increased risk of major hemorrhage. [70] The Asp irin in educing vents in the lderly (ASPREE) trial (N = 19,114) revealed that not only did aspirin have no effect on the primary outcome (death, dementia, disability) in elderly patients, but it led to a higher rate of major hemorrhage and the all-cause mortality was actually greater in the group taking aspirin than that of the placebo group. [71, 72] This unexpected finding of higher mortality was primarily atrributed to cancer-related death, which occurred in 3.1% of the aspirin users and in 2.3% of those in the placebo group. [72]

A 2019 systematic review and meta-analysis of data from 13 trials comprising 164,225 individuals without cardiovascular disease to evaluate the association between aspirin use and cardiovascular and bleeding events found a lower risk of cardiovascular events and a higher risk of major bleeding. [73]

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