The hazards of discontinuing acetylsalicylic acid therapy in those at risk of coronary artery disease.
OBJECTIVE
Drug compliance is important to maximize benefits and minimize risks; however, the importance of adherence to acetylsalicylic acid (i.e. aspirin) is pivotal in patients with or at risk of coronary artery disease. Given the recent developments in this research field, the high prevalence of coronary artery disease worldwide, and the intricacies of antiplatelet therapy after percutaneous coronary revascularization, we reviewed recent studies on aspirin discontinuation in those with or at risk of coronary artery disease.


RESULTS
Even in the most recent scientific literature, it appears clear that a sizable portion of patients at risk of coronary artery disease continue to discontinue aspirin during follow-up, either under physician's supervision or spontaneously. This fact has major adverse implications, as thrombotic events typically cluster early after aspirin discontinuation. Moreover, discontinuing aspirin appears hazardous for all patients with coronary artery disease, but such risk increases exponentially after percutaneous coronary intervention, especially with drug-eluting stents.


CONCLUSIONS
Life-long compliance to aspirin should be a major treatment goal in patients at risk of coronary artery disease, and supervised discontinuation of aspirin (e.g. before major noncardiac surgery) should last the minimum amount of time required and be bridged, when appropriate, by heparin therapy.
Lotrionte
Marzia
M
Institute of Cardiology, Catholic University, Rome, Italy.
Biondi-Zoccai
Giuseppe Gl
GG
D015906:Angioplasty, Balloon, Coronary; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage*; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D010349:Patient Compliance; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D018570:Risk Assessment; D012307:Risk Factors; D028761:Withholding Treatment
D000894:Anti-Inflammatory Agents, Non-Steroidal; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin