Landmark Study Challenges Decades-Old Aspirin Prescription for Heart Disease Prevention
PARIS – A major clinical trial, AQUATIC, is prompting a re-evaluation of long-held beliefs about aspirin’s role in preventing cardiovascular events, especially for patients already taking anticoagulants. The study, presented this week at the European Society of Cardiology (ESC) Congress, suggests that adding aspirin to anticoagulant therapy offers no additional benefit and significantly increases bleeding risk. This finding could lead to a shift in treatment guidelines,potentially ending the routine prescription of aspirin for secondary prevention in many heart patients.
For decades, low-dose aspirin has been a cornerstone of treatment for individuals with a history of heart attack, stroke, or other cardiovascular disease. Tho, AQUATIC’s results, involving over 4,000 patients, demonstrate that in those already on anticoagulants – medications that prevent blood clotting - aspirin provides no further protection against cardiac events and substantially elevates the risk of major bleeding. This is particularly relevant as an estimated 100 billion aspirin tablets are consumed globally each year,according to the World Health Association (WHO).
The implications are important for French cardiologists and beyond. Experts suggest that, for patients at high risk of bleeding, anticoagulant monotherapy – using a single anticoagulant medication – could become the new standard of care, replacing the common practice of combining aspirin with an anticoagulant.The European Society of Cardiology has indicated that future recommendations (expected in 2026) will consider these findings.
This isn’t the first sign that the “aspirin dogma” is weakening. The 2018 ASPREE study found that aspirin offered no net benefit for primary prevention – preventing a first cardiovascular event – in elderly individuals without prior heart disease, while increasing bleeding risk. in 2019, the COMPASS trial explored adding a low dose of the anticoagulant rivaroxaban to aspirin, achieving a modest benefit but also increasing bleeding risk.
AQUATIC reverses this logic,positioning aspirin as the potential ”overflow” risk when patients are already adequately protected by anticoagulants. These three studies collectively illustrate a growing understanding in cardiology: the need to carefully balance the benefits of antiplatelet and anticoagulant therapies against the risk of excessive bleeding.
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Aspirin, or acetylsalicylic acid, remains one of the most widely used medications in the world. Originally extracted from white willow bark, it was first synthesized by Bayer in 1897, before becoming the first medicine sold without a prescription.
