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.

Key Publications

NEWJun Dual Antiplatelet Therapy and Immediate Intensive Statin in Mild Ischemic Stroke: A Randomized Trial. (Neurology, 2026, PMID 42348803): "The aim of this study was to investigate the effect of combining clopidogrel-aspirin and immediate intensive statin in patients with acute mild ischemic stroke or transient ischemic attack (TIA)."
May Predicting the compressibility and compactibility profiles of pharmaceutical active ingredients for design of multi-component tablets. (International journal of pharmaceutics, 2026, PMID 42177921): "Five APIs with diverse mechanical properties, i.e., aspirin, carbamazepine, metronidazole, paracetamol, and theophylline, were investigated."
May Ticagrelor with aspirin dual antiplatelet therapy combined with intravenous thrombolysis in patients with ischaemic stroke in China (TAPIS): a multicentre, double-blind, randomised controlled trial. (Lancet (London, England), 2026, PMID 42114550): "We aimed to investigate the efficacy and safety of early oral dual antiplatelet therapy (DAPT), started within 6 h of onset, as an adjunct to intravenous thrombolysis."
Jun Modifiable Correlates With Systemic Thromboxane Generation and Association With Cardiovascular Outcomes: Results From the Framingham Heart Study. (Arteriosclerosis, thrombosis, and vascular biology, 2026, PMID 42021731): "Modifiable correlates with thromboxane A2 generation, including potential nonplatelet sources not readily affected by aspirin, are poorly understood."
Jun Early pregravid correction of hemostasis assessed by novel biomarkers improves the outcomes of pregnancies in women with bad obstetric history. (Clinical science (London, England : 1979), 2026, PMID 42012486): "All patients with BOH received enoxaparin (low molecular weight heparin (LMWH)) starting from the preconception period and aspirin after the tenth week of pregnancy."
Apr Synergistically enhanced aspirin loading and pH-triggered controlled release via a ZIF-L/ZIF-8 hierarchical coating on titanium. (Biomedical materials (Bristol, England), 2026, PMID 41990835): "...developed a pH-responsive drug delivery coating on titanium (Ti) implants for controlled aspirin release."
Jun Apixaban Versus Aspirin and Risk of Hemorrhage in the ARCADIA Trial. (Annals of neurology, 2026, PMID 41741942): "We compared bleeding end points on apixaban versus aspirin in the ARCADIA trial."
Jun Use of potential gerotherapeutic drugs and mortality in geriatric rehabilitation inpatients: RESORT. (Mechanisms of ageing and development, 2026, PMID 41713660): "However, compared to patients who did not use any, those using metformin (Hazard ratio (HR) 0.54; 95% confident interval (CI) 0.40 - 0.75), ACEi/ARBs (HR 0.71; 95% CI 0.56 - 0.91), aspirin (HR 0.74; 95% CI 0.57 - 0.96), and beta-blockers (HR 0.76; 95% CI 0.58 - 0.98) had a significantly lower 1-year post-discharge mortality after adjusting for Charlson Comorbidity Index."
May Net clinical benefit of extended dual pathway inhibition in chronic coronary syndrome as classified by the 2024 ESC criteria: a COMPASS substudy. (European heart journal. Cardiovascular pharmacotherapy, 2026, PMID 41614385): "Extended dual pathway inhibition (DPI) with aspirin and rivaroxaban is recommended in high-risk patients with chronic coronary syndrome (CCS)."
Aug Apixaban for stroke prevention in subclinical atrial fibrillation detected by an implantable cardiac monitor: A subgroup analysis of ARTESiA. (Heart rhythm, 2025, PMID 40752875): "The ARTESiA trial randomized patients with a pacemaker (PM), implantable cardioverter-defibrillator (ICD), or implantable cardiac monitor (ICM) and with subclinical atrial fibrillation to either apixaban or aspirin."