Aspirin is in the news again with the latest article published in JAMA this past week: A Practical Approach to Low-Dose Aspirin for Primary Prevention. Building on the ASPREE, ASCEND and ARRIVE trials and a recent meta-analysis: Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events: A Systematic Review and Meta-analysis, the authors offer a stepwise patient-centric approach.
The guidance follows the same principles I advocated in this post and the associated video:
With a stepwise shared decision-making matrix:
The biggest change is the reduction in the demonstrable effect of Aspirin in the prevention of cardiovascular disease in patients with no incidence of the disease. For anyone who has had any cardiovascular “defining event” the guidance is clear – Aspirin with or without another anti-platelet drug is mandatory:
After a CVD-defining event, use of aspirin, another antiplatelet agent, or both remains mandatory, although aspirin is underused for secondary prevention
For all others – understand the risk/benefit equation for you and make an informed decision.
