New guidelines for daily aspirin therapy

March 18, 2019

Photo of aspirin pills

For some older adults, a low-dose aspirin has been a daily staple of life to prevent a heart attack or stroke. Now, the American College of Cardiology and the American Heart Association have issued new guidelines recommending against low-dose aspirin therapy for adults older than 70 or anyone who is at higher risk of bleeding. The new guidelines follow the results last year of a large clinical trial by the National Institutes of Health, which found that daily aspirin did not prolong healthy, independent living among older adults without prior cardiovascular events.

Aspirin therapy has also been studied by UF Health cardiologists Anthony A. Bavry, M.D. and Ahmed N. Mahmoud, M.D. In 2017 and 2018, their two published analyses of 11 aspirin therapy clinical trials concluded that daily aspirin therapy does not save lives, causes additional bleeding and provided no benefit for patients with peripheral vascular disease, which causes narrowed arteries and reduced blood flow to the limbs.

Here, Dr. Bavry addresses some questions related to the new guidance:

What is most important for patients to know about the new aspirin therapy guidelines?

Recent research has found that aspirin may not save lives when used for primary prevention but it does increase major bleeding. Accordingly, updated guideline recommendations from the American College of Cardiology/American Heart Association have downgraded the use of aspirin for primary prevention. In summary, aspirin can still be considered on a case-by-case basis for 40-to-70-year-old individuals who are considered to be at highest risk.

Can certain patients still benefit from aspirin therapy? If so, which ones?

The current guidelines reserve the possible use of aspirin for primary prevention for the "highest risk" patients. However, who is "highest risk" is not precisely defined. As always, patients who are uncertain if aspirin is appropriate for them should discuss this topic with their cardiologist or medical provider.

How do the new recommendations fit in with your prior research?

We published an analysis which explored the use of aspirin for primary prevention. We failed to find a convincing benefit for aspirin therapy for primary prevention. In addition, aspirin was associated with important bleeding risks. This and other research helped to update guideline recommendations.

What do the new guidelines suggest to you about an emerging medical consensus on aspirin therapy?

Through ongoing research, the cardiovascular community is coming to the realization that aspirin may not offer all the benefit we formerly thought it was capable of.