Aspirin Therapy Guidelines

Introduction to Aspirin

Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) with antiplatelet properties, primarily used for the prevention and treatment of cardiovascular diseases, according to the American College of Cardiology 1, 2

For patients with acute coronary syndrome, an initial loading dose of 162-325mg orally is recommended, as suggested by the American Heart Association 3
A maintenance dose of 75-100mg of low-dose aspirin is recommended, according to the European Society of Cardiology 3, 4
Non-enteric coated aspirin is preferred, and chewing the tablet is recommended for rapid effect in the acute phase, as per the American College of Cardiology guidelines 3

For patients with acute ischemic stroke or transient ischemic attack (TIA), a single loading dose of 160-325mg is recommended after excluding intracranial hemorrhage, as suggested by the American Heart Association 5
For patients with difficulty taking oral medication, rectal administration (325mg/day) or enteral administration (81mg/day) is a reasonable alternative, according to the American Stroke Association 5

Low-dose aspirin for the prevention of preeclampsia is recommended, with a dose range of 75-162mg based on risk factors, as suggested by the American College of Obstetricians and Gynecologists 6
Initiation of aspirin therapy should be before 16 weeks of gestation, but no later than 20 weeks, according to the American College of Obstetricians and Gynecologists 6

When used in combination with ticagrelor, the maintenance dose of aspirin should be 100mg/day or less, as recommended by the American College of Cardiology 3
Combination with nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided as much as possible for the management of ischemic pain, according to the European Society of Cardiology 3
For patients at high risk of gastrointestinal bleeding, concomitant use of proton pump inhibitors is recommended, as suggested by the European Heart Journal 7

The main side effect of aspirin is gastrointestinal bleeding, which increases with dose and duration of use, as reported by the Annals of Internal Medicine 8
High-dose aspirin increases the risk of gastrointestinal bleeding compared to low-dose aspirin, according to the Journal of the American College of Cardiology 3, 9