Clear Up Confusion About Aspirin for CV Primary Prevention

You'll be asked whether "an aspirin a day" is still good for the heart...based on new U.S. Preventive Services Task Force recommendations.

Help patients sort out the facts. This is a case of guidance catching up with the evidence.

Recommend aspirin 81 mg/day for SECONDARY prevention...such as after a heart attack or stroke, or with angina or peripheral artery disease.

Remind these patients not to stop aspirin, since it can be lifesaving...and CV benefits clearly outweigh bleeding risks.

Aspirin for PRIMARY prevention is a different story.

A new analysis confirms benefits are generally outweighed by risks. Using aspirin for primary prevention for up to 10 years avoids a CV event in 1 in 250 patients...but leads to major bleeding in 1 in 200.

Primary prevention might have a small net benefit in select patients with high CV and low bleeding risk. But it doesn't seem to improve length or quality of life for most patients over 60.

Don't routinely recommend starting aspirin for primary prevention...even for patients with diabetes or multiple CV risks.

Clarify that even aspirin 81 mg/day can lead to bleeding. And special forms (enteric-coated, buffered, etc) don't cause less GI bleeding...since risk seems mainly due to aspirin's systemic effects.

Ask if patients take OTC aspirin when you're updating med lists. Share that evidence about its role in primary prevention has evolved.

Weigh patient risks and preferences. For example, point out that bleeding risk goes up with age...and aspirin is one more pill to take.

Reinforce other ways to reduce CV risk, such as lifestyle changes...smoking cessation...and managing BP, lipids, and diabetes.

Explain that it's usually appropriate to stop aspirin for primary prevention. Discuss with prescribers or encourage patients to follow up.

Educate that aspirin doesn't need to be "self-tapers" as new platelets are made. Plus bleeding risk in primary prevention likely outweighs any theoretical risk of "rebound" events.

Get our resource, Aspirin for CV Primary Prevention, for more talking points...and aspirin's role in colon cancer prevention.

Key References

  • JAMA. 2022 Apr 26;327(16):1577-1584
  • JAMA. 2022 Apr 26;327(16):1585-1597
  • JAMA. 2022 Apr 26;327(16):1598-1607
  • Circulation. 2019 Sep 10;140(11):e596-e646
Pharmacist's Letter Canada. June 2022, No. 380601

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