The hazards of discontinuing acetylsalicylic acid therapy in those at risk of coronary artery disease

PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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. © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins.