Table 1

Primary prevention of arterial atherothrombosis events in guidelines

OrganisationYearRecommendation
The Canadian Stroke Best Practice182020Aspirin is no longer recommended for primary prevention in individuals without a history of symptomatic CVD, stroke or PAD; the harms of daily aspirin use could potentially outweigh the benefits.
American Diabetes Association172020Aspirin therapy (75–162 mg/day) may be considered as a primary prevention strategy in those with diabetes who are at increased cardiovascular risk, after a comprehensive discussion with the patient on the benefits versus the comparable increased risk of bleeding.
American College of Cardiology/American Heart Association Guideline on the primary prevention of CVD192019Low-dose aspirin (75–100 mg orally daily) might be considered for the primary prevention of ASCVD among select adults 40–70 years of age who are at higher ASCVD risk but not at increased bleeding risk.
Low-dose aspirin (75–100 mg orally daily) should not be administered on a routine basis for the primary prevention of ASCVD among adults >70 years of age.
Low-dose aspirin (75–100 mg orally daily) should not be administered for the primary prevention of ASCVD among adults of any age who are at increased risk of bleeding.
European Guidelines on CVD prevention in clinical practice162016Antiplatelet therapy is not recommended in individuals without CVD due to the increased risk of major bleeding.
US Preventive Services Task Force (USPSTF)152016The USPSTF recommends initiating low-dose aspirin use for the primary prevention of CVD in adults aged 50–59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years and are willing to take low-dose aspirin daily for at least 10 years. (Grade B recommendation)
The decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 60–69 years who have a 10% or greater 10-year CVD risk should be an individual one. Persons who are not at increased risk for bleeding have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years are more likely to benefit. Persons who place a higher value on the potential benefits than the potential harms may choose to initiate low-dose aspirin. (Grade C recommendation)
The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD and CRC in adults aged 70 years or older or in adults younger than 50 years. (Grade I recommendation)
  • ASCVD, atherosclerotic cardiovascular disease; PAD, peripheral artery disease.