Some issues of administering acetylsalicylic acid in clinical practice

This article reviews some issues related to the long-term administration of antithrombotic drugs for primary and secondary cardiovascular prevention. It does not address initial management of acute coronary syndromes or periprocedural use of antithrombotic therapies. We review the pros and cons regarding acetylsalicylic acid (ASA) therapy in primary prevention based on the available evidence, including recent data linking ASA with cancer protection. We do not include other antiplatelet therapies (e. g., clopidogrel alone or in combination with aspirin) or oral anticoagulation (e. g., warfarin), because they are not likely to be used in primary prevention setting. Recent guidelines depend on the accurate assessment of cardiovascular risk as part of decision-making process. While awaiting the results of several ongoing studies, we argue for a pragmatic approach to use low-dose ASAin primary cardiovascular prevention and discussits use in patients at high cardiovascular risk. Patients with diabetes mellitus are known to have an increased risk of cardiovascular events. Low dose ASA is recommended for secondary prevention, as for primary prevention it can be prescribed in patients with diabetes mellitus and at high cardiovascular risk. Antiplatelet therapy is the standard of care for the secondary prevention of coronary artery disease and ischemic stroke. However, it is associated with increased risk of bleeding, first of all gastrointestinal bleeding. Prescription of proton pump inhibitors along with antiplatelet therapy reduces the risk of upper gastro-intestinal bleeding.