A joint analysis of studies, the Antiplatelet Trialist ‘Collaboration, devoted to evaluating the effectiveness of antiplatelet agents in various clinical manifestations of atherosclerosis, showed the possibility of reducing the risk from cardiovascular causes. Acetylsalicylic acid (ASA) was the most popular tool in studies subjected to meta-analysis. Despite convincing evidence of the feasibility of antiplatelet therapy obtained in evaluating many antiplatelet agents, only ASC is recommended as the gold standard. On the one hand, ASA drugs are recognized as the gold standard of antiplatelet therapy, but on the other hand, they cause side effects: gastropathy, gastrointestinal bleeding. Therefore, to ensure a balance between efficacy and safety, minimum doses of ASA (75–150 mg) are recommended.
In recent years, the niche for the use of Aspirin ® has significantly expanded . It has become possible to use this drug in high-risk patients, that is, as mentioned above, individuals without clinical manifestations of atherosclerosis [94]. This is evidenced by the results of a large-scale study, which included 4495 people with at least one of the traditional RF of coronary heart disease – age> 65 years, hypertension, hypercholesterolemia, diabetes, obesity, premature development of myocardial infarction in close relatives. Study participants were randomized to receive either Rowan 100 mg Aspirin ® Cardio or placebo. For 3.5 years of intervention among 2226 who took Aspirin ® 17 people died of cardio-vascular causes, and among 2269, in the control group, 31 patients died of these same causes – a 44% reduction in risk (p <0.05). Currently, in a number of recommendations, aspirin in small doses is recommended as an antiplatelet therapy not only for patients with clinical manifestations of atherosclerosis, but also for persons without clinical manifestations, but with a high risk (risk is more than 10% on the scale).
Nevertheless, according to the general opinion, the ratio of the effectiveness and safety of using aspirin in secondary prophylaxis exceeds a similar indicator when using this drug as a means of primary prophylaxis. In this regard, an individual approach and an assessment of the benefit / risk ratio is required when prescribing aspirin for primary prevention of SSO.