Do We Still Need Aspirin in Coronary Artery Disease?

Authors

Muhammad Haisum Maqsood
Glenn N Levine
Neal D Kleiman
David Hasdai
Barry F Uretsky
Yochai Birnbaum

Publication Date

12-6-2023

Journal

Journal of Clinical Medicine

DOI

10.3390/jcm12247534

PMID

38137601

PMCID

PMC10743767

PubMedCentral® Posted Date

12-6-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

acute coronary syndrome, aspirin, clopidogrel, P2Y12 inhibitors, percutaneous coronary intervention, primary prevention, secondary prevention, stable coronary artery disease, ticagrelor

Abstract

Aspirin has for some time been used as a first-line treatment for acute coronary syndromes, including ST-elevation myocardial infarction, for secondary prevention of established coronary disease, and for primary prevention in patients at risk of coronary artery disease. Although aspirin has been in use for decades, the available evidence for its efficacy largely predates the introduction of other drugs, such as statins and P2Y12 inhibitors. Based on recent trials, the recommendation for aspirin use as primary prevention has been downgraded. In addition, P2Y12 inhibitors given as a single antiplatelet therapy have been associated with a lower incidence of bleeding than dual antiplatelet therapy in combination with aspirin in patients with stable and unstable coronary artery disease. The aim of this review is to discuss the role of aspirin considering the available evidence for primary prevention, secondary prevention for stable coronary artery disease or acute coronary syndromes, and after percutaneous coronary intervention or coronary artery bypass revascularization.

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