Low-dose ASA in stable coronary disease

Should we prescribe low-dose acetylsalicylic acid (ASA) for all patients with stable coronary disease?

Gerd Hasenfuß, MD: It is a lifelong treatment in patients with stable coronary artery disease, but there are some exceptions. If a patient needs anticoagulation, for example, for atrial fibrillation, with vitamin K antagonists or new oral anticoagulants, then aspirin should be stopped one year after the coronary event, after percutaneous coronary intervention (PCI), or acute coronary syndrome. So one year after the coronary event, if a patient needs anticoagulation, aspirin should be stopped, but if no anticoagulation is needed, then aspirin should be used lifelong in this patient.

The question is, “Should it be used in high-risk patients without coronary artery disease?” The answer to this question is no. It is no means to reduce the risk of getting coronary artery disease, so in patients without coronary artery disease or cardiovascular atherosclerosis, aspirin should not be used. It has been shown, in particular in a study coming from Japan, that it does not lower cardiovascular risk but increases bleeding risk.