Aspirin: Friend or Foe?
Keywords: low-dose aspirin, antithrombotic effects, cardiovascular disease, cyclooxygenase, platelets
AbstractAspirin can be regarded as one of the oldest drugs still in use in modern-day medicine. Since 1979, different actions of aspirin have been flourishing, including the acetylation of platelet cyclooxygenase, which inhibits thromboxane formation and explains its antithrombotic effects. Since those first reports, aspirin remains the cornerstone of antiplatelet therapy for different indications. Low-dose aspirin is the single most cost-effective medicine for the prevention of the secondary events of thrombosis. Low-dose aspirin has been found to selectively inhibit the synthesis of thromboxane A2, by preferentially inhibiting the COX-1 isozyme, without having much effect on prostacyclin. It has been indicated in the prevention of colon cancer, cardiovascular diseases, such as myocardial infarction, strokes and atherothrombotic events, as well as the reduction in risk of developing pre-eclampsia during pregnancy. Low-dose aspirin does not increase blood pressure, cause renal impairment, or interfere with the antihypertensive effects of angiotensin-converting enzyme (ACE) inhibitors or diuretics. Many of the risk factors, like risk for bleeding, gastrointestinal bleeding and intracranial haemorrhage, increase with age. Every patient’s treatment needs to be individualised to decide whether the potential benefits outweigh any potential harm. The benefits in secondary prevention are favourable, and efforts should be made to ensure that all patients with symptomatic cardiovascular or cerebrovascular disease are treated with low-dose aspirin on a regular basis.
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