Protagonist of Aspirin in Primary Treatment of Cardiovascular Disease: An Overview

Abstract

Abstract

Aspirin (ASA) is the most used medication on the globe. The benefits of aspirin therapy for the secondary prevention of cardiovascular disease clearly outweigh the risks of bleeding, and low- dose aspirin is uniformly recommended in this condition. While the clinical use of aspirin in secondary cardiovascular disease (CVD) prevention remains undisputed, its role in primary prevention is controversial. Recently, three trials of primary prevention reported neutral net benefit results or evidence of harm for aspirin in patients with no evident CVD. Based on meta-analyses incorporating latest trials in the field of primary prevention, the modest reduction in ischemic events with aspirin, if any, is offset by a modest increase in nonfatal bleeding. Improved control of CVD risk factors and broader use of statins may have reduced the thrombotic complications of atherosclerosis, thus limiting the opportunity for aspirin to prevent clinical CVD events in the contemporary era. As such, decision-making about aspirin for primary prevention is challenging even when selected patients are considered and involves careful weighing of risks and benefits. Clinical aspirin resistance is defined as the failure to prevent the occurrence of atherothrombotic ischaemic episodes in patients to whom it is administered. So far, there is no generally accepted method for the ex vivo evaluation of platelet activation or for assessing the degree of platelet activation following aspirin administration and data concerning the clinical impact of aspirin resistance are conflicting. For these reasons it is not possible to suggest specific guidelines for the treatment of patients who show high levels of platelet activation or a low level of platelet inhibition after treatment with aspirin. The aim of this review is to present data related to role of aspirin, resistance to aspirin, and to discuss the possible causes, the clinical significance, and the ways of managing such resistance at a clinical level.

Keywords: Aspirin, cardiovascular disease, management, Pharmacology, resistance

Cite this Article

Asad Jamal Ansari, Mohd Imran, Anuradha Mishra, Afreen Usmani, Nishat Fatima, Mohd Ajaml. Protagonist of Aspirin in Primary Treatment of Cardiovascular Disease: An Overview. Research & Reviews: Journal of Medical Science and Technology. 2020; 9(2): 12–30p.