The Current Clinical Application Status and Pharmacological Mechanism of Aspirin

Aspirin (acetylsalicylic acid), a long-standing drug, has evolved from an antipyretic and analgesic to a multi-purpose agent, especially in cardiovascular disease prevention. Recently, its potential has extended to cancer prevention, pregnancy complications, and neurodegenerative diseases, though debates on efficacy and safety persist. Current evidence shows limited net benefit of low-dose aspirin in primary cardiovascular prevention due to bleeding risks, while its role in colorectal cancer prevention varies by population, dose, and duration. New derivatives like NO-aspirin may reduce gastrointestinal toxicity, but require further study. Aspirin’s mechanisms—beyond COX-1/2 inhibition—include possible effects on immune modulation and epigenetic regulation, though these are not yet fully understood. Its anticancer potential may involve enhancing tumor antigen presentation and modulating the tumor microenvironment. Clinical trials suggest limited benefit in preventing colorectal cancer recurrence post-surgery, except possibly in patients not treated with oxaliplatin. Gastrointestinal side effects remain a major concern, but strategies like PPI co-treatment or genotyping may reduce risks. This review highlights aspirin’s prospects in precision medicine, emphasizing the need for genomic and epigenetic biomarkers to guide its use, and calls for further studies on non-COX pathways, AI-based risk assessment, and expanded clinical trials to optimize its role in complex disease management.