More than 150 years after acetylsalicylic acid was synthesized by French chemist Charles Frédéric Gerhardt, aspirin is still one of the most prescribed medications worldwide. In 2018, several trials have suggested that the role of aspirin in the contemporary era might be less pre-eminent than in previous decades.
Key advances
-
The risk–benefit ratio of aspirin does not seem to be beneficial in the primary prevention of cardiovascular disease, including in high-risk patients such as those with diabetes mellitus and elderly individuals1,2,7.
-
Aspirin always increases the risk of bleeding when prescribed either alone or in combination with other antiplatelet or anticoagulant drugs1,2,4,5,7.
-
Aspirin can be removed from the antithrombotic regimen immediately after percutaneous coronary intervention in patients receiving anticoagulant therapy plus clopidogrel; safety is then improved and efficacy preserved5.
-
P2Y12 antagonist monotherapy after coronary stenting is currently being tested to replace dual antiplatelet therapy; although statistically neutral, the first study on P2Y12 antagonist monotherapy to be published, the GLOBAL LEADERS trial, showed promising results6.
This is a preview of subscription content, access via your institution
Access options
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 / 30 days
cancel any time
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Gaziano, J. M. et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet 392, 1036–1046 (2018).
The ASCEND Study Collaborative Group. Effects of aspirin for primary prevention in persons with diabetes mellitus. N. Engl. J. Med. 379, 1529–1539 (2018).
Antithrombotic Trialists’ Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 373, 1849–1860 (2009).
Ridker, P. M. Should aspirin be used for primary prevention in the post-statin era? N. Engl. J. Med. 379, 1572–1574 (2018).
Golwala, H. B. et al. Safety and efficacy of dual versus triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: a systematic review and meta-analysis of randomized clinical trials. Eur. Heart J. 39, 1726–1735a (2018).
Vranckx, P. et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months versus aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet 392, 940–949 (2018).
McNeil, J. J. et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N. Engl. J. Med. 379, 1509–1518 (2018).
Bonaca, M. P. et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N. Engl. J. Med. 372, 1791–1800 (2015).
Eikelboom, J. W. et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N. Engl. J. Med. 377, 1319–1330 (2017).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
G.M. has received research grants from Abbott, Actelion, Amgen, AstraZeneca, Bayer, Beth Israel Deaconess Medical Center, Boehringer Ingelheim, Boston Scientific, Brigham and Women’s Hospital, Bristol-Myers Squibb, Cardiovascular Research Foundation, Daiichi-Sankyo, Elsevier, Europa, Fédération Française de Cardiologie, ICAN, Idorsia, Journal of the American College of Cardiology, Lead-Up, Lilly, Medtronic, Menarini, MSD, Novo Nordisk, Pfizer, Sanofi, Servier, The Mount Sinai School of Medicine, TIMI Study Group and WebMD.
Rights and permissions
About this article
Cite this article
Montalescot, G. A farewell to aspirin in primary prevention?. Nat Rev Cardiol 16, 76–77 (2019). https://doi.org/10.1038/s41569-018-0148-z
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41569-018-0148-z
This article is cited by
-
Dual-pathway inhibition for secondary and tertiary antithrombotic prevention in cardiovascular disease
Nature Reviews Cardiology (2020)
-
Prevention and Treatment of Acute Stroke in the Nonagenarians and Beyond: Medical and Ethical Issues
Current Treatment Options in Neurology (2019)