Numerous clinical trials acknowledged the role of thrombosis in the pathophysiology of acute coronary syndromes, and have now conclusively demonstrated the role of antiplatelet treatment in the secondary prevention of cardiovascular adverse events, with an acceptable risk of bleeding.1–4 Implementing this treatment is still controversial in primary prevention settings. In fact, in the population without previous cardiovascular events, aspirin—the sole antithrombotic compound studied in sufficiently large group of patients—provide for a significant reduction of the risk of first myocardial infarction, but at an increased risk of gastrointestinal bleeding and haemorrhagic stroke.
Accordingly, both international guidelines and expert opinion statements differ on their recommendations, reflecting a significant uncertainty as to the risk/benefit ratio of the treatment.5
Furthermore, during the last few years has been pointed out a clear role of aspirin in the prevention of certain tumours, particularly of the gastrointestinal tract, and specifically of the colon-rectum.
Using aspirin in primary prevention settings requires the effort to individualize the treatment, after careful evaluation of the haemorrhagic risk vis-a-vis the possibility to develop, in the mid-term and long-term follow-up, major cardiovascular events or gastrointestinal cancer.
To facilitate this task a new app for mobile phones has been developed (Aspirin-Guide decision support tool), which calculates the ischaemic risk and the haemorrhagic risk according to diagnostic algorithms which consider the ‘number needed to treat and to harm’ derived from the literature, and then provides the 10 years risk of cardiovascular events according to age and gender of the patient, and also considering the potential benefit in prevention of colorectal cancer.
Conflict of interest: none declared.
References
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