Balancing the risk and benefits of low-dose aspirin in clinical practice

• Published in: Baillière's best practice & research. Clinical gastroenterology Vol. 26; no. 2; pp. 173 - 184
• Main Authors: Casado-Arroyo, Rubén, MD, Gargallo, Carla, MD, Lanas Arbeloa, Ángel, MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-04-2012; Elsevier Limited
• Subjects: Aspirin; Aspirin - administration & dosage; Aspirin - adverse effects; Cardiovascular disease; Cardiovascular Diseases - prevention & control; Colorectal Neoplasms - prevention & control; Drug therapy; Gastroenterology and Hepatology; Gastrointestinal Hemorrhage - chemically induced; Gastrointestinal Hemorrhage - prevention & control; GI damage; Heart attacks; Hemorrhage - chemically induced; Hemorrhage - prevention & control; Humans; Mortality; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Prevention cardiovascular diseases; Primary Prevention; Proton pump inhibitors; Risk Assessment; Secondary Prevention; Upper Gastrointestinal Tract - drug effects; Proton pump inhibitors; Aspirin; GI damage; Prevention cardiovascular diseases
• ISSN: 1521-6918; 1532-1916
• DOI: 10.1016/j.bpg.2012.01.015

Antiplatelet agents are widely used in primary and secondary prevention of cardiovascular events. The scientific evidence has provided strong support for the benefits of aspirin in decreasing the risk of cardiovascular events in a wide range of pathologies. The relatively rare occurrence of major bleeding complications should not be underestimated, mainly due to its high morbi-mortality. The assessment of both gastrointestinal risk and cardiovascular benefits of low-dose aspirin for any individual patient may be difficult in clinical practice. In this review, we summarize the evidence supporting the efficacy of aspirin and the risks of side effects due to hemorrhagic complications. This article proposes a unifying framework for application to help the clinician in the decision making process of individuals who have different risk of cardiovascular and bleeding events with different examples. Finally, new developments in the field directed towards individualized risk assessment strategies are described.