Guidelines on Aspirin Use | Bayer® Aspirin Resources for HCPs

CLINICAL PRACTICE GUIDELINES SUPPORT ASPIRIN USE IN SECONDARY CV EVENT PREVENTION

Practice guidelines recommend aspirin as a top-tier, first-line treatment option.

Condition/Indication Recommendation for Aspirin Use,
Including Dose and Time Frame
Supporting Guidelines
Recurrent MI Non-enteric-coated, chewable aspirin (162-325 mg) should be given to all patients with NSTE ACS without contraindications as soon as possible after presentation; a maintenance dose of aspirin (81-325 mg/d) should be continued indefinitely (class I, level A). AHA/ACC 2014 Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes1
STEMI
  • Aspirin (162-325 mg) should be given before primary PCI (class I, level B).
  • After PCI, aspirin should be continued indefinitely (class I, level A).
  • — 81 mg/d is the preferred maintenance dose (class IIa, level B).
2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction2
NSTEMI Non-enteric-coated, chewable aspirin (162-325 mg) should be given to all patients with NSTE ACS without contraindications as soon as possible after presentation; a maintenance dose of aspirin (81-325 mg/d) should be continued indefinitely (class I, level A). AHA/ACC 2014 Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes1
Chronic Stable Angina Pectoris Aspirin (75-162 mg/d) should be continued indefinitely in the absence of contraindications in patients with stable ischemic heart disease (class I, level A). 2012 ACCF/AHA/ACP/AATS/ PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients with Stable Ischemic Heart Disease3
Unstable Angina Pectoris Non-enteric-coated, chewable aspirin (162-325 mg) should be given to all patients with NSTE ACS without contraindications as soon as possible after presentation; a maintenance dose of aspirin (81-325 mg/d) should be continued indefinitely (class I, level A). AHA/ACC 2014 Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes1
Post-CABG
  • Aspirin (81-325 mg/d) should be administered preoperatively and within 6 hours after CABG, then continued indefinitely to reduce graft occlusion and adverse cardiac events (class I, level A).
  • After off-pump CABG, dual antiplatelet therapy with aspirin (81-162 mg/d) plus clopidogrel (75 mg/d) should be administered for 1 year to reduce graft occlusion (class I, level A).
  • In patients who present with ACS, it is reasonable to administer combination antiplatelet therapy after CABG with aspirin plus either prasugrel or ticagrelor (preferred over clopidogrel); prospective clinical trial data from CABG populations are not yet available (class IIa, level B).
  • As sole antiplatelet therapy after CABG, it is reasonable to consider aspirin at a higher (325 mg/d) rather than a lower dose (81 mg/d), presumably to prevent aspirin resistance, but the benefits are not well-established (class IIa, level A).
  • Combination therapy with aspirin plus clopidogrel for 1 year after on-pump CABG may be considered in patients without recent ACS, but the benefits are not well-established (class IIb, level A).
AHA 2015 Statement on Secondary Prevention After Coronary Artery Bypass Graft Surgery4
Post-PCI
  • Dual antiplatelet therapy (in the form of aspirin plus a P2Y12 inhibitor) is indicated for ≥12 months in patients undergoing stent implantation (class I, level B).
  • Dual antiplatelet therapy in the form of aspirin plus either clopidogrel, ticagrelor or prasugrel is recommended for >12 months after PCI, unless there are contraindications such as excessive risk of bleeding (class IIb, level A).
ACC/AHA 2016 Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients with Coronary Artery Disease5
Carotid Endarterectomy (CEA)

Aspirin (81-325 mg/d) is recommended before CEA and may be continued indefinitely postoperatively (class I, level A).

Beyond the first month after CEA, aspirin (75-325 mg/d), clopidogrel (75 mg/d) or the combination of low-dose aspirin (25 mg) plus extended-release dipyridamole (200 mg) twice daily should be administered for long-term prophylaxis against ischemic cardiovascular events (class I, level B).

In women who are to undergo CEA, aspirin is recommended unless contraindicated. NOTE: A specific aspirin dose is not given for this recommendation (class I, level C).

ASA/ACCF/AHA 2011 Guidelines6

AHA/ASA 2014 Stroke Prevention Guidelines for Women7

Recurrent Ischemic Stroke and TIA Aspirin (50-325 mg/d) monotherapy, the combination of aspirin (25 mg) and extended-release dipyridamole (200 mg) twice daily, or clopidogrel (75 mg) is indicated as initial therapy after TIA or ischemic stroke for prevention of future stroke (class I, level A for monotherapy; class I, level B for combination with dipyridamole; class IIb, level B for clopidogrel). AHA/ASA 2014 Guidelines for Stroke Prevention After Stroke or TIA8
clinical practice guidelines sheet

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AATS=American Association for Thoracic Surgery; ACC=American College of Cardiology; ACCF=American College of Cardiology Foundation; ACP=American College of Physicians; ACS=acute coronary syndrome; AHA=American Heart Association; ASA=American Stroke Association; CABG=coronary artery bypass graft; MI=myocardial infarction; NSTE=non-ST-segment elevation; NSTEMI=non-ST-elevation myocardial infarction; PCI=percutaneous coronary intervention; PCNA=Preventive Cardiovascular Nurses Association; SCAI=Society for Cardiovascular Angiography and Interventions; STEMI=ST-elevation myocardial infarction; STS=Society of Thoracic Surgeons; TIA=transient ischemic attack.

References: 1. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes. J Am Coll Cardiol. 2014;64:e139-228. 2. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA Guideline for the management of ST-elevation myocardial infarction. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61:e78-140. doi:10.1016/j.jacc.2012.11.019. 3. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/ SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol. 2012;60(24):e44-e164. 4. Kulik A, Ruel M, Jneid H, et al. Secondary prevention after coronary artery bypass graft surgery: a scientific statement from the American Heart Association. Circulation. 2015;131(10):927-964. doi:10.1161/CIR.0000000000000182. 5. Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease. Circulation. 2016;134(10):e123-e155. doi:10.1161/CIR.0000000000000404. 6. Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ACCF/AHA/AANN/ AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. Stroke. 2011;42:e464-e540. 7. Bushnell C, McCullough LD, Awad IA, et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:1545-1588. 8. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160-2236.