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Erschienen in: Current Atherosclerosis Reports 3/2018

01.03.2018 | Coronary Heart Disease (S. Virani and S. Naderi, Section Editors)

Weighing the Anti-Ischemic Benefits and Bleeding Risks from Aspirin Therapy: a Rational Approach

verfasst von: Sagar Dugani, Jeffrey M. Ames, JoAnn E. Manson, Samia Mora

Erschienen in: Current Atherosclerosis Reports | Ausgabe 3/2018

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Abstract

Purpose of Review

The role of aspirin in secondary cardiovascular prevention is well understood; however, the role in primary prevention is less clear, and requires careful balancing of potential benefits with risks. Here, we summarize the evidence base on the benefits and risks of aspirin therapy, discuss clinical practice guidelines and decision support tools to assist in initiating aspirin therapy, and highlight ongoing trials that may clarify the role of aspirin in cardiovascular disease prevention.

Recent Findings

In 2016, the USPSTF released guidelines on the use of aspirin for primary prevention. Based on 11 trials (n = 118,445), aspirin significantly reduced all-cause mortality and nonfatal myocardial infarction, and in 7 trials that evaluated aspirin ≤ 100 mg/day, there was significant reduction in nonfatal stroke. The USPSTF recommends individualized use of aspirin based on factors including age, 10-year atherosclerotic cardiovascular disease risk score, and bleeding risk. Several ongoing trials are evaluating the role of aspirin in primary prevention, secondary prevention, and in combination therapy for atrial fibrillation. Evidence-based approaches to aspirin use should consider the anti-ischemic benefits and bleeding risks from aspirin. In this era of precision medicine, tools that provide the personalized benefit to risk assessment, such as the freely available clinical decision support tool (Aspirin-Guide), can be easily incorporated into the electronic health record and facilitate more informed decisions about initiating aspirin therapy for primary prevention.

Summary

Aspirin has a complex matrix of benefits and risks, and its use in primary prevention requires individualized decision-making. Results from ongoing trials may guide healthcare providers in identifying appropriate candidates for aspirin therapy.
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Metadaten
Titel
Weighing the Anti-Ischemic Benefits and Bleeding Risks from Aspirin Therapy: a Rational Approach
verfasst von
Sagar Dugani
Jeffrey M. Ames
JoAnn E. Manson
Samia Mora
Publikationsdatum
01.03.2018
Verlag
Springer US
Erschienen in
Current Atherosclerosis Reports / Ausgabe 3/2018
Print ISSN: 1523-3804
Elektronische ISSN: 1534-6242
DOI
https://doi.org/10.1007/s11883-018-0717-y

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The Interplay of Lipids, Lipoproteins, and Immunity in Atherosclerosis

Women and Ischemic Heart Disease (E. Jackson, Section Editor)

Imaging to Assess Ischemic Heart Disease in Women

Women and Ischemic Heart Disease (A. Maran, Section Editor)

Gender Differences in Epidemiology, Pathophysiology, and Treatment of Hypertension

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