The latest guidelines from the "ACCP Thrombosis Guidelines" states "yes" but perhaps just barely. Aspirin has long been known for its valuable role in secondary protection whether it be in post-MI management, as well as in post-CVA or PVOD care. It also has clear benefit and a critical role in patients undergoing vascular interventions. Whether these benefits translate into the broader general population for primary prevention is muted by the increased risk for bleeding and gastrointestinal irritation. Beneficial effects on mortality in some cancers has also been described for aspirin. The answer from this leading panel suggests a small mortality benefit for the general population, thus warranting it in patients over the age of 50 who do not suffer from gastrointestinal distress. The recommendations state that individual choices should be made based on the patient's risk status for either thrombotic events or bleeding risk.
Data is further complicated by a lack of clear consensus on aspirin dose-whether a baby aspirin or an adult aspirin will suffice, and in whom. A recent example of this came out in the Plato trial on Ticargrelor for dual anti platelet effect in the setting of ACS patients undergoing PCI. In that trial, "usual use" aspirin dosing differed between European and American sites, leading to conflicting results and prompting the FDA to approve Ticargrelor but only for use with baby aspirin at 81mg, but not with adult dose aspirin at 325mg.
POSTED BY STEVEN C. AJLUNI, MD
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