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Canadian stroke best practices provides recommendations for the use of acetylsalicylic acid (asa) for prevention of vascular events. Both guidelines will likely lead to an increased recognition of bleeding risk with asa, and we anticipate a marked reduction in asa use for primary prevention of cvd, particularly in older age groups. Abstract aspirin protects against atherothrombosis while increasing the risk of major bleeding

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Although it is widely used to prevent cardiovascular disease (cvd), its benefit does not outweigh its risk for primary cvd prevention in large population settings. We evaluated the effect of asa use, compared with no asa, on ischemic and bleeding events in patients without known atherosclerotic cardiovascular diseases In 2018, 3 large randomized controlled trials comparing asa to placebo for primary prevention were published

Asa consistently increased the risk of bleeding, and offered a modest benefit only for those with diabetes, as summarized in the following table:

There is a new recommendation not to initiate aspirin in adults 60 years or older for primary prevention The evidence is unclear whether aspirin use reduces the risk of colorectal cancer incidence or mortality How to implement this recommendation Over the past several decades, there has been great interest to identify individuals for whom the clinical benefit of aspirin for the prevention of a first heart attack or stroke (primary prevention) exceeds the risk of bleeding.

There are 3 important questions to ask regarding asa for primary prevention, as there are patients who might actually benefit from asa and there are risks associated with discontinuation of asa in patients who are already taking it. Since the publication of the 2010 canadian antiplatelet guidelines, several large randomized controlled trials (rcts) have evaluated the role of aspirin (asa) use in primary prevention.