Aspirin Therapy for Cardiovascular Risk Reduction

Introduction to Aspirin Therapy

The American Diabetes Association recommends aspirin therapy for adults with a history of myocardial infarction, stroke, or any atherosclerotic cardiovascular disease, using 75-162 mg daily indefinitely 1, 2, 3
The American Heart Association suggests that aspirin should be continued at a dose of 75-100 mg daily after the initial dual antiplatelet therapy period following coronary revascularization 3

The American College of Cardiology recommends aspirin 75-162 mg daily for primary prevention in adults aged 40-59 years with a 10-year cardiovascular disease risk ≥10% who are not at increased bleeding risk 4
For patients with diabetes mellitus aged ≥50 years with ≥1 additional major risk factor, aspirin 75-162 mg daily may be considered if not at increased bleeding risk 1, 2, 3
The American Diabetes Association states that aspirin should not be prescribed for primary prevention in adults ≥60 years, regardless of cardiovascular risk, as bleeding risks outweigh benefits in this age group 2

The recommended dose of aspirin is 75-162 mg daily, with 81 mg being the most common formulation in the United States 1, 2, 3
Doses >162 mg do not provide additional cardiovascular benefit but significantly increase bleeding risk 4
The lowest effective dose (75-81 mg) minimizes gastrointestinal bleeding while maintaining efficacy 1, 2

Major bleeding risk is approximately 2-5 per 1,000 patients per year 1, 2
High bleeding risk factors include age >70 years, history of gastrointestinal ulcers or bleeding, anemia, chronic kidney disease, and concurrent use of NSAIDs, anticoagulants, or corticosteroids 2, 3, 4
The American Heart Association recommends that aspirin should not be prescribed in patients with active bleeding, recent gastrointestinal bleeding, known aspirin allergy, bleeding disorders, or concurrent anticoagulation therapy 1, 2, 3, 4

For patients with documented aspirin allergy, clopidogrel 75 mg daily is recommended as an alternative 1, 2, 3
Following acute coronary syndrome, dual antiplatelet therapy (aspirin + P2Y12 inhibitor) is recommended for at least 1 year 1, 2, 3