aspirin

Overview

Aspirin (acetylsalicylic acid) is one of the most widely used and extensively studied pharmacological agents in medicine, classified as a non-steroidal anti-inflammatory drug (NSAID) with potent antiplatelet, analgesic, antipyretic, and anti-inflammatory properties. Its primary mechanism of action involves irreversible inhibition of cyclooxygenase (COX) enzymes — specifically COX-1 and COX-2 — which blocks the conversion of arachidonic acid to prostaglandins and thromboxane A2 (TXA2). By suppressing platelet-derived TXA2, a potent platelet activator and vasoconstrictor, aspirin reduces platelet aggregation and thrombus formation, making it a cornerstone therapy in the prevention and management of cardiovascular and cerebrovascular disease. Its antiplatelet effects are permanent for the lifespan of a given platelet (~7–10 days), as platelets lack the nuclear machinery to synthesize new COX enzyme.

Beyond cardiovascular indications, aspirin is employed in a broad range of clinical settings including obstetric complications, antiphospholipid syndrome, ischemic stroke, and chronic coronary syndrome. It is often used in combination with other antithrombotic agents — including anticoagulants such as rivaroxaban, apixaban, and warfarin, as well as P2Y12 inhibitors such as clopidogrel and ticagrelor — to achieve additive or synergistic inhibition of thrombotic pathways. Emerging research also explores novel drug delivery platforms for aspirin and its potential role in reducing mortality in aging populations, reflecting the breadth of its pharmacological relevance.

Focus of Latest Publications

Recent publications have focused on aspirin mainly in combination antithrombotic strategies and in settings where its clinical benefit or safety is being compared with other therapies. In acute ischemic stroke and transient ischemic attack, aspirin was studied as part of dual antiplatelet therapy with clopidogrel, including a randomized trial evaluating whether adding immediate intensive statin therapy provides additional benefit, and another multicentre randomized trial assessing early ticagrelor-aspirin dual antiplatelet therapy as an adjunct to intravenous thrombolysis. These studies were designed to clarify the efficacy and safety of early intensified antiplatelet treatment, although the abstracts provided do not report final outcome results.

Aspirin was also examined in cardiovascular prevention and bleeding-risk contexts. In the ARCADIA trial, apixaban was compared with aspirin for bleeding endpoints, and in ARTESiA, patients with subclinical atrial fibrillation were randomized to apixaban or aspirin for stroke prevention. In chronic coronary syndrome, aspirin was part of extended dual pathway inhibition with rivaroxaban in a COMPASS substudy evaluating net clinical benefit under updated ESC high-risk criteria. Another study in the Framingham Heart Study investigated systemic thromboxane A2 generation and its association with cardiovascular outcomes, noting that some thromboxane sources may not be readily affected by aspirin.

Beyond thrombosis and cardiovascular disease, aspirin appeared in studies of pregnancy management and geriatric outcomes. In women with bad obstetric history, aspirin was given after the tenth week of pregnancy together with preconception enoxaparin, with dynamic laboratory monitoring showing progressive improvement in hemostasis and platelet function and more favorable pregnancy outcomes without hemorrhagic complications. In geriatric rehabilitation inpatients, aspirin was one of several repurposed drugs associated with lower 1-year post-discharge mortality, though not with changes in physical function or readmission.

Aspirin was also investigated in pharmaceutical formulation research. One study included aspirin among five active pharmaceutical ingredients used to develop a digital method for predicting compressibility and compactibility profiles in multi-component tablets, successfully estimating tablet solid fraction and tensile strength for binary and ternary mixtures. Another study developed a pH-responsive titanium implant coating based on ZIF-L/ZIF-8 that enhanced aspirin loading and enabled controlled release, with excellent cytocompatibility and improved proliferation of osteoblastic cells, supporting potential use in promoting osseointegration.