Key result
Enteric-coated aspirin inhibits TxA2 less effectively than plain aspirin and fails to reduce GI bleeding.
Why the study?
Different aspirin formulations have been developed to reduce gastrointestinal complications of chronic low-dose aspirin used for cardiovascular prevention, but their pharmacological efficacy and gastrointestinal safety require evaluation.
Do different aspirin formulations (enteric-coated, buffered) improve gastrointestinal safety or maintain efficacy compared to plain aspirin in subjects requiring cardiovascular prevention?
Do different aspirin formulations (enteric-coated, buffered) improve gastrointestinal safety or maintain efficacy compared to plain aspirin in subjects requiring cardiovascular prevention?
Plain aspirin should be the preferred formulation for cardiovascular prevention due to its superior pharmacological efficacy and the lack of proven gastrointestinal safety benefits from enteric-coated or buffered formulations.
May favor plain aspirin for CV prevention; leaves open RCTs on clinical outcomes.
Aspirin inhibits platelet function by irreversibly inhibiting the synthesis of thromboxane A2 (TxA2). Aspirin, at low doses, is widely used for cardiovascular prevention. Gastrointestinal discomfort, mucosal erosions/ulcerations and bleeding are frequent complications of chronic treatment. To reduce these adverse effects, different formulations of aspirin have been developed, including enteric-coated (EC) aspirin, the most widely used aspirin formulation. However, EC aspirin is less effective than plain aspirin in inhibiting TxA2 production, especially in subjects with high body weight. The inadequate pharmacological efficacy of EC aspirin is mirrored by lower protection from cardiovascular events in subjects weighing >70 kg. Endoscopic studies showed that EC aspirin causes fewer erosions of the gastric mucosa compared to plain aspirin (which is absorbed in the stomach) but causes mucosal erosions in the small intestine, where it is absorbed. Several studies demonstrated that EC aspirin does not reduce the incidence of clinically relevant gastrointestinal ulceration and bleeding. Similar results were found for buffered aspirin. Although interesting, the results of experiments on the phospholipid-aspirin complex PL2200 are still preliminary. Considering its favorable pharmacological profile, plain aspirin should be the preferred formulation to be used for cardiovascular prevention.
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Clerici et al. (2023) conducted a review in Cardiovascular prevention. Enteric-coated and buffered aspirin vs. Plain aspirin was evaluated on Pharmacological efficacy (TxA2 inhibition) and gastrointestinal safety. Enteric-coated aspirin is less effective than plain aspirin in inhibiting TxA2 production, especially in subjects >70 kg, and does not reduce clinically relevant gastrointestinal bleeding.
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