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ANTITHROMBOTIC THERAPY IN 2018

A farewell to aspirin in primary prevention?

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From Nature Reviews Cardiology

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More than 150 years after acetylsalicylic acid was synthesized by French chemist Charles Frédéric Gerhardt, aspirin is still one of the most prescribed medications worldwide. In 2018, several trials have suggested that the role of aspirin in the contemporary era might be less pre-eminent than in previous decades.

Key advances

  • The risk–benefit ratio of aspirin does not seem to be beneficial in the primary prevention of cardiovascular disease, including in high-risk patients such as those with diabetes mellitus and elderly individuals1,2,7.

  • Aspirin always increases the risk of bleeding when prescribed either alone or in combination with other antiplatelet or anticoagulant drugs1,2,4,5,7.

  • Aspirin can be removed from the antithrombotic regimen immediately after percutaneous coronary intervention in patients receiving anticoagulant therapy plus clopidogrel; safety is then improved and efficacy preserved5.

  • P2Y12 antagonist monotherapy after coronary stenting is currently being tested to replace dual antiplatelet therapy; although statistically neutral, the first study on P2Y12 antagonist monotherapy to be published, the GLOBAL LEADERS trial, showed promising results6.

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Fig. 1: Aspirin in different CVD prevention situations.

References

  1. Gaziano, J. M. et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet 392, 1036–1046 (2018).

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  7. McNeil, J. J. et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N. Engl. J. Med. 379, 1509–1518 (2018).

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  9. Eikelboom, J. W. et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N. Engl. J. Med. 377, 1319–1330 (2017).

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Authors and Affiliations

  1. Sorbonne University, ACTION Study Group, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France

    Gilles Montalescot

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  1. Gilles Montalescot
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Correspondence to Gilles Montalescot.

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Competing interests

G.M. has received research grants from Abbott, Actelion, Amgen, AstraZeneca, Bayer, Beth Israel Deaconess Medical Center, Boehringer Ingelheim, Boston Scientific, Brigham and Women’s Hospital, Bristol-Myers Squibb, Cardiovascular Research Foundation, Daiichi-Sankyo, Elsevier, Europa, Fédération Française de Cardiologie, ICAN, Idorsia, Journal of the American College of Cardiology, Lead-Up, Lilly, Medtronic, Menarini, MSD, Novo Nordisk, Pfizer, Sanofi, Servier, The Mount Sinai School of Medicine, TIMI Study Group and WebMD.

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Montalescot, G. A farewell to aspirin in primary prevention?. Nat Rev Cardiol 16, 76–77 (2019). https://doi.org/10.1038/s41569-018-0148-z

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