Optimizing low-dose aspirin therapy
| Suggested action . | Reference . | Clinical implication . |
|---|---|---|
| Use the lowest effective dose (ie, 75-100 mg daily) | 30,-32 | Maximize clinical efficacy; minimize gastrointestinal toxicity and drug-drug interactions |
| Consider BID dosing in patients with type 2 diabetes mellitus and essential thrombocythemia | 34,,-37 | Ensure persistent inhibition of platelet function throughout the dosing interval; clinical benefit remains untested |
| Prefer nonenteric-coated formulations | 40,43,44 | Improve extent and duration of platelet inhibition |
| Improve adherence | 42 | Avoid misclassification of “resistance” |
| Avoid concomitant administration of ibuprofen and naproxen | 45,,-48,50 | Avoid interference with the antiplatelet effect of low-dose aspirin |
| Avoid concomitant administration of gastrotoxic medications (NSAIDs and high-dose corticosteroids) | 89 | Improve gastrointestinal safety |
| Consider proton pump inhibitors in high-risk patients. Consider eradication in Helicobacter pylori–positive patients. | 63,90 | Improve gastrointestinal safety |
| Suggested action . | Reference . | Clinical implication . |
|---|---|---|
| Use the lowest effective dose (ie, 75-100 mg daily) | 30,-32 | Maximize clinical efficacy; minimize gastrointestinal toxicity and drug-drug interactions |
| Consider BID dosing in patients with type 2 diabetes mellitus and essential thrombocythemia | 34,,-37 | Ensure persistent inhibition of platelet function throughout the dosing interval; clinical benefit remains untested |
| Prefer nonenteric-coated formulations | 40,43,44 | Improve extent and duration of platelet inhibition |
| Improve adherence | 42 | Avoid misclassification of “resistance” |
| Avoid concomitant administration of ibuprofen and naproxen | 45,,-48,50 | Avoid interference with the antiplatelet effect of low-dose aspirin |
| Avoid concomitant administration of gastrotoxic medications (NSAIDs and high-dose corticosteroids) | 89 | Improve gastrointestinal safety |
| Consider proton pump inhibitors in high-risk patients. Consider eradication in Helicobacter pylori–positive patients. | 63,90 | Improve gastrointestinal safety |
Modified with permission from Patrono.17