The FDA has approved an over-the-counter (OTC) liquid-filled capsule formulation of aspirin (Vazalore – PLx Pharma). The manufacturer has been heavily promoting Vazalore with claims of fast, predictable absorption and antiplatelet activity and improved gastrointestinal safety compared to existing OTC aspirin formulations.

The FDA has approved Yosprala (Aralez), a fixed-dose combination of delayed-release aspirin and immediate-release omeprazole, for secondary prevention of cardiovascular and cerebrovascular events in patients who are at risk of developing aspirin-associated gastric ulcers (≥55 years old or history of gastric ulcers). Yosprala is the first product to become available in the US that combines aspirin and a proton pump inhibitor (PPI).

Aspirin is now widely used for antithrombotic prophylaxis in patients who have had angina pectoris or a myocardial infarction and has also been tried in healthy people to prevent myocardial infarction. Recent studies have focused on increasingly lower doses of the drug. The use of aspirin in patients who have had transient ischemic attacks or strokes will not be discussed here.

Taking aspirin to prevent recurrence or worsening of cardiovascular disease has become a common practice in recent years (Medical Letter, 28:31, 1986). Now, the US Food and Drug Administration is considering whether aspirin can also be advertised for prevention of a first myocardial infarction in previously healthy people.

The American College of Obstetricians and Gynecologists (ACOG) and the US Preventive Services Task Force (USPSTF) have recommended that women at risk for preeclampsia take low-dose aspirin daily after the first trimester.

Some readers have asked whether the widespread practice of taking aspirin to prevent first heart attacks is justifiable and, if so, what the dose should be. Only one large well-designed study has tested the use of aspirin for this purpose.

The FDA has approved Durlaza (New Haven Pharmaceuticals), a 24-hour extended-release (ER) aspirin formulation available only by prescription, for secondary prevention of myocardial infarction (MI) and stroke.

One of our readers has suggested that more attention should have been paid to a study comparing the antiplatelet effects of immediate-release and enteric-coated aspirin that appeared in Circulation last year.1 The safety benefits of enteric-coated aspirin are unclear. It may protect against dyspepsia, but not against major gastrointestinal bleeding, which is thought to be mainly a systemic effect of prostaglandin inhibition.ANTIPLATELET EFFECTS OF ASPIRIN — Aspirin irreversibly acetylates cyclooxygenase-1, blocking thromboxane synthesis and inhibiting platelet activation and aggregation for...

Low-dose aspirin is widely used as an antiplatelet drug to reduce the risk of cardiovascular disease (Medical Letter 2000; 42:18). Recent reports suggest that the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen (Motrin, and others) may decrease the efficacy of aspirin for this indication. The manufacturer of Tylenol is capitalizing on these reports by advertising that aspirin-taking patients who need pain relief should use acetaminophen instead of ibuprofen.

When the use of aspirin for primary prevention of cardiovascular diseases was last reviewed in The Medical Letter, only one placebo-controlled prospective trial was available: the (male) Physicians' Health Study. Last year, a second large, randomized, placebo-controlled study was reported as part of the Women's Health Study. Recently a sex-specific meta-analysis of 6 trials, including these two, was published.