Acetylsalicylic acid in primary prevention: a review

Abstract

The role of acetylsalicylic acid in secondary cardiovascular prevention is established. However, its role in primary prevention is much more controversial. In this review, we analyzed meta-analyses and trials regarding aspirin in primary prevention and, consequently, hemorrhagic risk related to anti-platelet therapy. Several factors have been considered (e.g., sex, comorbidities, bleeding risk factors, concomitant drugs, weight, age), aspirin’s pharmacokinetics included. In the end, we tried to individualize anti-aggregation therapy based on the risk/benefit ratio of every single subject. In conclusion, high-cardiovascular-risk subjects must be treated with acetylsalicylic acid in primary prevention according to their bleeding risk. For better cardiovascular stratification, other tools to detect risk modifier factors should be used (e.g., instrumental evaluations).

Keywords

• ASA
• primary prevention
• bleeding