SUMMARY AND RECOMMENDATIONS
●In patients without prior cardiovascular disease events, aspirin decreases the risk of nonfatal myocardial infarction and likely results in small decreases in overall mortality but increases the risk of major bleeding. Aspirin possibly reduces the risk of colorectal cancer over long-term follow-up (with >10 years of treatment). (See 'Prevention of CVD events' above and 'Prevention of cancer' above and 'Reducing all-cause mortality' above and 'Bleeding' above.)
●Estimates of the very small absolute benefits and risks of aspirin in primary prevention are provided in a table (table 1). Clinicians can use these estimates as a starting point for discussions with individual patients. Not all informed patients will choose to use aspirin and individual discussion is imperative. (See 'Assessing benefits and risks' above.)
●Factors to be considered in this discussion include assessment of the individual's risk for each outcome (cardiovascular events, colorectal cancer, bleeding, and total mortality); assessment of the relative value the individual places on preventing specific outcomes; assessment of the patient's attitude to inconvenience of long-term daily therapy; and value placed on immediate increase in risk of bleeding versus delayed potential benefit on death. (See 'Individualizing decisions' above.)
●In many adults, the benefits of aspirin exceed the risks (principally bleeding). For individuals age ≥50 years without excess bleeding risk, we suggest low-dose daily aspirin (75 to 100 mg) (Grade 2B). Patients who are more concerned about the bleeding risks than the potential benefits may reasonably choose to not take aspirin for primary prevention. (See 'Assessing benefits and risks' above.)
UPTODATE