Aspirin strategy for secondary prevention of atherosclerotic cardiovascular diseases: A narrative review

Aspirin is the most used antiplatelet agent for secondary prophylaxis of atherosclerotic cardiovascular diseases. Individual variability in aspirin responsiveness has been widely reported. The current recommendations do not take these variations into consideration. Current guidelines recommend 75–100 mg of once-daily aspirin in all patients for secondary prevention. However, “one-dose-fits-all” may not be the appropriate aspirin dosing strategy. Based on our review, we suggest that patients with inadequate aspirin responsiveness are at increased risk of recurrent cardiovascular events. Noncompliance is the most common cause of poor aspirin response. Ensuring adequate compliance and avoiding concomitant ingestion of nonaspirin nonsteroidal anti-inflammatory drugs and bedtime ingestion of aspirin can help achieve adequate aspirin-mediated antiplatelet activity. A low-dose, twice-daily regimen is the preferred strategy in “high-risk” groups.