Optimal Aspirin Dose in Acute Coronary Syndromes: an Emerging Consensus

Abstract

Numerous clinical trials testing the efficacy of aspirin for the secondary prevention of cardiovascular disease have been published. We reviewed the literature pertaining to aspirin dose in acute coronary syndrome patients. Clinical trials assessing the comparative efficacy of different doses of aspirin are scarce. This complex antiplatelet therapy landscape makes it difficult to identify the best aspirin dose for optimizing efficacy and minimizing risk of adverse events, while complying with the various guidelines and recommendations. Despite this fact, current evidence suggests that aspirin doses of 75-100 mg/day may offer the optimal benefit:risk ratio in acute coronary syndrome patients.

P2Y12 antagonists in non-ST-segment elevation acute coronary syndromes: latest evidence and optimal use

“…The pharmacologic mechanism for this interaction has not been determined. Notwithstanding, lower dose of aspirin are recommended in most ACS patients because higher doses offer no extra efficacy regardless of the P2Y12 inhibitor used [Dinicolantonio et al 2014].…”

Is Aspirin Still the Cornerstone of Antiplatelet Therapy in Patients With Coronary Artery Disease? An Historical and Practical Narrative Review

“…In patients with prior acute coronary syndrome (ACS), the optimal dose to prevent new events was 160 mg; the number of haemorrhagic events (including fatal ones) at this dosage was comparable to those caused by 80 mg daily. 8,9 Given all these findings, the optimal dosage of aspirin has not yet been clearly identified, even if a range of doses within which the efficacy and safety of aspirin was tested is known. The absence of an optimal dose explains the subtle differences between recommendations of European and American cardiologic societies.…”