Aspirin Therapy Changes in Clinical Guidelines
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Aspirin therapy is no longer suggested for primary prevention for most patients over age 40 but now advised that the decision whether to use aspirin for primary prevention of cardiovascular disease and cancer be made based on shared decision-making, taking into account the probable benefits and harms of aspirin relative to the specific patient.
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Solution Summary
While it was previously suggested that aspirin for primary prevention for most patients over age 40 is prudent, based on recent trials indicating that the benefits and harms are so closely balanced, there is no recommendation for or against aspirin use.
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In secondary prevention of cardiovascular disease (CVD), the absolute benefits of aspirin on occlusive events are greater than the absolute harm of major bleeding. However, for primary prevention, three recent large randomized trials evaluating all-cause mortality associated with aspirin use indicate that the benefits and harms of aspirin for primary prevention are very closely balanced [1-5]. In both, the ASCEND trial in patients with diabetes as well as the ARRIVE trial in patients with moderate CVD risk, the risk of all-cause death was similar with or without aspirin [1,5]. In the ...
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