Aspirin Therapy Guidelines

Introduction to Aspirin Indications

The American Heart Association recommends aspirin 75-162 mg daily for patients with established atherosclerotic cardiovascular disease, as it reduces vascular events by 20-28% 1, 4, 6
The American Diabetes Association suggests that aspirin is generally not recommended for primary prevention in most patients, particularly those over 70 years old, due to bleeding risks that outweigh benefits 2

Aspirin 75-162 mg daily is strongly recommended for patients with coronary artery disease (stable angina, prior myocardial infarction, post-PCI) 1
Aspirin 75-325 mg daily is recommended for patients with prior ischemic stroke or TIA 1
Aspirin 75-325 mg daily is recommended for patients with symptomatic peripheral artery disease 1, 3
Aspirin reduces stroke risk in patients post-carotid endarterectomy 4
A loading dose of 162-325 mg aspirin is recommended for acute coronary syndrome, followed by 75-162 mg daily 5, 6
Aspirin reduces death/recurrent stroke by 9 per 1000 patients treated in acute ischemic stroke 6

Aspirin is not recommended for primary prevention in adults over 70 years without established cardiovascular disease, due to bleeding risks that exceed benefits 2
Aspirin may be considered for primary prevention in patients with diabetes and additional high-risk features, but with careful consideration of bleeding risks 2, 7
Aspirin may be considered for primary prevention in patients under 70 years with high cardiovascular risk (10-year risk >10%), but with careful consideration of bleeding risks 7

Aspirin 100-325 mg daily is recommended for patients post-coronary artery bypass grafting, starting within 6 hours post-surgery 1
Aspirin 100 mg daily prevents thrombotic complications in patients with polycythemia vera 4, 5

Aspirin is contraindicated in patients with active gastrointestinal bleeding, hemophilia or other bleeding disorders, and aspirin allergy 1, 6
Aspirin should be used with caution in patients under 21 years due to the risk of Reye syndrome 2

Maintenance therapy with aspirin 75-162 mg daily is preferred over higher doses, as it reduces bleeding risks while maintaining efficacy 1, 2, 4, 5
Loading doses of 162-325 mg aspirin are recommended for acute events, such as acute coronary syndrome or acute ischemic stroke 5, 6

Enteric-coated aspirin formulations should be avoided for acute treatment due to slower absorption and potentially inadequate platelet inhibition 4
Aspirin should not be combined with warfarin unless absolutely necessary, as it significantly increases bleeding risk 1