Aspirin Prophylaxis Indications

Secondary Prevention Indications

The American Heart Association recommends aspirin (75-100 mg daily) for secondary prevention in patients with acute myocardial infarction, prior myocardial infarction, stable and unstable angina, prior stroke or transient ischemic attack, and established atherosclerotic cardiovascular disease 1, 2, 3, 4
For patients with documented aspirin allergy who require antiplatelet therapy, the American Diabetes Association suggests clopidogrel (75 mg daily) as an alternative 4
Dual antiplatelet therapy (aspirin plus P2Y12 inhibitor) is recommended for at least 1 year following acute coronary syndrome by the American College of Cardiology 3, 4

The American Stroke Association recommends primary prevention with aspirin for individuals at high cardiovascular risk where benefits outweigh bleeding risks, including persons with 10-year cardiovascular risk >10% 2, 5, 6
The American Heart Association suggests aspirin prophylaxis for women >65 years of age with controlled blood pressure and high cardiovascular risk, as well as women with multiple cardiovascular risk factors (hypertension, hyperlipidemia, diabetes) 6, 7

Patients with chronic kidney disease (estimated GFR <45 mL/min/1.73 m²) may benefit from aspirin for primary prevention, according to the American Stroke Association 2
The American College of Cardiology recommends prophylactic aspirin (75-100 mg daily) for patients with high-risk antiphospholipid profile (triple-positive or double-positive antiphospholipid testing) and for patients with systemic lupus erythematosus and high-risk antiphospholipid profile 8

The American College of Cardiology recommends a maintenance dose of 75-100 mg daily for secondary prevention 1
For primary prevention, the American Diabetes Association suggests a dose of 75-100 mg daily when indicated 7, 4
Lower doses (75-100 mg) are preferred over higher doses (>100 mg) for long-term use to minimize bleeding risk while maintaining efficacy, according to the American Heart Association 5

The American Diabetes Association reports that the main adverse effect of aspirin is increased gastrointestinal bleeding risk (up to 5 per 1,000 per year in real-world settings) 3, 4
For adults with ASCVD risk >1% per year, the number of cardiovascular events prevented will be similar to or greater than bleeding events induced, according to the American College of Cardiology 4
Risk factors for increased bleeding include age >70 years, uncontrolled hypertension, concomitant use of other NSAIDs or anticoagulants, and history of gastrointestinal bleeding, as reported by the American Heart Association 5, 9, 4