Low-dose aspirin has been recommended and used for decades for prevention of ASCVD. It is well established for SECONDARY prevention of ASCVD, however, recent studies have shown aspirin should not be used for routine PRIMARY prevention of ASCVD due to lack of benefit. It is also important to avoid aspirin if there is increased risk of bleeding or a history of GI bleeding, PUD, older than 70 years, thrombocytopenia, coagulopathy, chronic kidney disease, and concurrent NSAIDs, steroids, and anticoagulants. Low-dose aspirin might be considered for primary prevention of ASCVD in select higher risk ASCVD patients aged 40-70 years without bleeding risk.
For more information, see PEPID Article or the 2019 ACC/AHA guidelines.