EMERGING EVIDENCE THAT MAKES A BIG DIFFERENCE

Safety

Enteric-coated aspirin 100 mg/day causes significantly less
gastroduodenal damage vs. plain aspirin.

Enteric-coated aspirin 100 mg/day significantly lowers
gastroduodenal damage vs. plain aspirin.1

  • A literature review of 27 trials and systematic reviews reported that there is a fine balance between the risks and benefits of aspirin use in primary prevention.2
  • Heart attacks may require complex Lifelong interventions for those who survive.3
  • <4 cases/1000 person-years may suffer from GI bleeding with long-term low-dose aspirin usage.4

GI: gastrointestinal; CHD: coronary heart disease; CAC: coronary artery calcium; CVD: cardiovascular disease; ASCVD: atherosclerotic cardiovascular disease; NNH: number needed to harm; NSAIDs: nonsteroidal anti-inflammatory drugs; H. pylori: Helicobacter pylori.

References

  1. Dammann H, Burkhardt F, Wolf N. Enteric coating of aspirin significantly decreases gastroduodenal mucosal lesions. Alimentary Pharmacology & Therapeutics. 1999;13(8):1109-1114.
  2. Sutcliffe P, Connock M, Gurung T, et al. Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews. Health Technol Assess. 2013;17(43):1-253.
  3. Elwood PC, Morgan G, Galante J, et al. Systematic Review and Meta-Analysis of Randomised Trials to Ascertain Fatal Gastrointestinal Bleeding Events Attributable to Preventive Low-Dose Aspirin: No Evidence of Increased Risk. PLoS One. 2016;11(11):e0166166.
  4. García Rodríguez LA, Martín-Pérez M, Hennekens CH, Rothwell PM, Lanas A. Bleeding Risk with Long-Term Low-Dose Aspirin: A Systematic Review of Observational Studies. PLoS One. 2016;11(8):e0160046.
  5. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646.
  6. Langsted A, Nordestgaard BG. Smoking is Associated with Increased Risk of Major Bleeding: A Prospective Cohort Study. Thromb Haemost. 2019;119(1):39-47.
  7. Weisman SM, Graham DY. Evaluation of the Benefits and Risks of Low-Dose Aspirin in the Secondary Prevention of Cardiovascular and Cerebrovascular Events. Arch Intern Med. 2002;162(19):2197-2202.
  8. Raber I, McCarthy CP, Vaduganathan M, et al. The rise and fall of aspirin in the primary prevention of cardiovascular disease. Lancet. 2019;393(10186):2155-2167.
  9. Delaney JA, Opatrny L, Brophy JM, Suissa S. Drug-drug interactions between antithrombotic medications and the risk of gastrointestinal bleeding. CMAJ. 2007;177(4):347-351.