Table 6.

Recommendations and concerns regarding aspirin use in Asian and Western populations

Aspirin is underutilized in high-risk patients in both Asian and Western countries, which indicates a need for educational initiatives and improved physician-patient communication across all countries Risk estimation scores are useful guides for determining the threshold at which aspirin should be used; however, greater validation is needed in countries such as Japan, India and in South Asia. Until validated scores are available, physicians should be aware of the limitations and should monitor risk factors that are relevant to their patient but are not covered in all scores (eg, triglyceride levels in Japanese patients or high density lipoprotein cholesterol in South Asians) Large-scale trials addressing the benefits of aspirin in preventing recurrent events in Asian populations are needed; the prevention of recurrent myocardial infarction may be higher in Chinese patients Underutilization of aspirin in Asian countries may be linked to an overestimation of bleeding risks. It is possible that a higher prevalence of Helicobacter pylori infection and genetic differences may make Asian populations more susceptible to gastrointestinal bleeding. Until further trials are available, very low aspirin doses and even the wide use of gastroprotective agents may be the optimal approach to high-risk patients in Asian countries