Revised suggestion for an old drug: aspirin

Derived from willow bark, aspirin has been used as an analgesic and anti inflammatory drug since ancient Greek civilizations. Extracted and purified into salicylic acid, it was first officially introduced within the early twentieth century within the drug form we all know today (Ittaman, VanWormer, and Rezkalla, 2014). In 1971, the precise mechanism of motion of aspirin was discovered as a non-selective cyclooxygenase (COX) inhibitor, and later it was discovered that it exerts an anticoagulant effect by stopping platelet aggregation at low doses (75–100 mg/day), also generally known as “baby aspirin” . “

Currently, aspirin is a reasonable nonsteroidal anti-inflammatory drug (NSAID) that’s widely beneficial for the prevention of significant heart problems (CVD) similar to myocardial infarction (MI) or ischemic stroke in high-risk individuals. Scientists began studying aspirin as a safety measure for people and not using a history of heart problems, and it was studied rigorously from the Eighties to the early 2000s. Several studies have shown a big reduction in the danger of major cardiovascular events, including nonfatal heart attack, stroke, or cardiovascular death. This led many organizations, similar to the US Preventive Services Task Force (USPSTF), to support the usage of low-dose aspirin in 2016 for the first prevention of heart problems.

However, this suggestion has been controversial attributable to the increased risk of bleeding complications which will occur with aspirin use. An evaluation of 10 studies found that aspirin use was related to a 58% increase in the speed of major gastrointestinal bleeding, while one other evaluation of 11 clinical trials found a rise in the speed of intracranial bleeding within the aspirin group in comparison with the control group (USPSTF, 2021). Last October, the USPSTF issued changes to its aspirin recommendations, stating that the choice to initiate low-dose aspirin for primary CVD prevention in adults aged 40 to 59 years who’ve a 10-year risk of CVD is 10% or more, must be taken individually and discussed along with your doctor. They also recommend starting low-dose aspirin for primary prevention of heart problems in adults aged 60 years and older. New evidence from pooled analyzes showed that low-dose aspirin didn’t significantly reduce fatal myocardial infarction, stroke, cardiovascular mortality, or all-cause mortality (USPSTF, 2021).

The 2019 American College of Cardiology (ACC) and American Heart Association (AHA) Guidelines for the Primary Prevention of Cardiovascular Disease already included the next recommendations regarding aspirin use (Arnett et al., 2019):

• Low-dose aspirin (75–100 mg orally every day) could also be considered for the first prevention of atherosclerotic heart problems (ASCVD) in chosen adults aged 40 to 70 years who’re at higher risk of ASCVD without an increased risk of bleeding.
• Low-dose aspirin shouldn’t be routinely administered for primary prevention of ASCVD in adults older than 70 years.
• Low-dose aspirin shouldn’t be administered for primary prevention of ASCVD in adults of any age who’re at increased risk of bleeding.

Science is consistently evolving, and as recent evidence emerges, it’s critical that each one healthcare professionals stay informed. A straightforward anticoagulant pill that saves some people’s lives might be fatal for others. Before initiating treatment with aspirin, a careful review of the patient’s medical history and bleeding risk, similar to gastrointestinal bleeding, peptic ulcer, thrombocytopenia, coagulopathy, or blood-thinning medications, must be performed.

Arnett, D.K., Blumenthal, R.S., Albert, M.A., Buroker, A.B., Goldberger, Z.D., Hahn, E.J., Himmelfarb, C.D., Khera, A., Lloyd-Jones, D., McEvoy, J.W., Michos, E.D., Miedema, M. D., Muñoz, D., Smith, S. C., Jr, Virani, S. S., Williams, K. A., Sr., Yeboah, J., & Ziaeian, B. (2019). 2019 ACC/AHA Guidelines for Primary Prevention of Cardiovascular Disease: Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. , (11), e596–e646. https://doi.org/10.1161/CIR.0000000000000678

Ittaman, S. V., VanWormer, J. J., & Rezkalla, S. H. (2014). The role of aspirin within the prevention of cardiovascular diseases. , (3-4), 147–154. https://doi.org/10.3121/cmr.2013.1197

U.S. Preventive Services Task Force (2021, October 12). Use of aspirin for the prevention of heart problems: preventive medications (draft statement of suggestion). https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/aspirin-use-to-prevent-cardiovascular-disease-preventive-medication