Key result
Aspirin loses favor for primary CAD prevention while P2Y12 monotherapy reduces bleeding versus dual therapy.
Why the study?
Much of the evidence for aspirin predates modern therapies such as statins and P2Y12 inhibitors, prompting reevaluation of its role in coronary artery disease.
Does aspirin remain necessary for primary and secondary prevention in patients with or at risk for coronary artery disease?
Does aspirin remain necessary for primary and secondary prevention in patients with or at risk for coronary artery disease?
This review highlights the evolving and potentially diminishing role of aspirin in coronary artery disease management, particularly in primary prevention and in favor of P2Y12 inhibitor monotherapy to reduce bleeding.
Answers are grounded in this paper and cite their sources.
Aspirin de-escalation warrants caution in primary prevention; leaves open optimal P2Y12 monotherapy strategies pending dedicated trials.
Aspirin has for some time been used as a first-line treatment for acute coronary syndromes, including ST-elevation myocardial infarction, for secondary prevention of established coronary disease, and for primary prevention in patients at risk of coronary artery disease. Although aspirin has been in use for decades, the available evidence for its efficacy largely predates the introduction of other drugs, such as statins and P2Y12 inhibitors. Based on recent trials, the recommendation for aspirin use as primary prevention has been downgraded. In addition, P2Y12 inhibitors given as a single antiplatelet therapy have been associated with a lower incidence of bleeding than dual antiplatelet therapy in combination with aspirin in patients with stable and unstable coronary artery disease. The aim of this review is to discuss the role of aspirin considering the available evidence for primary prevention, secondary prevention for stable coronary artery disease or acute coronary syndromes, and after percutaneous coronary intervention or coronary artery bypass revascularization.
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Maqsood et al. (2023) conducted a review in Coronary Artery Disease. Aspirin was evaluated. Aspirin's role in primary prevention of coronary artery disease has been downgraded based on recent trials, and P2Y12 inhibitor monotherapy shows lower bleeding incidence than dual therapy.
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