Summary of European guidelines for aspirin

January 2020

The purpose of this document is to keep a working list of European guidelines with information on aspirin.  The guidelines themselves should be read for further information.

Primary prevention of cardiovascular disease 

Key Message: “Antiplatelet therapy is not recommended in individuals free from CVD, due to the increased risk of major bleeding.” European Society of Cardiology (ESC) 2016

The 2016 European guidelines on CVD prevention review the evidence for antiplatelet therapy in individuals without CVD and conclude that current evidence does not support the use of aspirin in those without CVD due to the risk of a major bleed.

The ESC 2019 guidelines on diabetes (DM), pre-diabetes, and cardiovascular disease state:

  • “Patients with DM and symptomatic CVD should be treated no differently to patients without DM
  • In patients with DM at moderate CV risk, aspirin for primary prevention is not recommended
  • In patients with DM at high/very high risk, aspirin may be considered in primary prevention

In addition the ESC 2019 diabetes guidelines identify the following gaps in the evidence relating to platelet use in people with diabetes:

  • Type 1 diabetes and CVD prevention [in vivo platelet activation has been reported]
  • Body mass and antiplatelet responsiveness especially in those with diabetes and obesity where higher dose strategies need investigation
  • Are antithrombotic effects similar in pre-DM and DM?

Secondary prevention of cardiovascular disease

The 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes recommended aspirin for CVD event prevention at a dose of 75-100 mg daily in patients with previous MI or revascularization. In addition, aspirin 75-100 mg daily can also be considered for people without a history of MI or revascularization but where there is evidence of coronary artery disease using imaging tests.

The 2016 European Guidelines for CVD prevention make the following recommendations for antiplatelet therapy (see table below). This is a based on a careful appraisal of risks versus benefits of aspirin or other antiplatelet therapy.  The guidelines state that there is a gap in the evidence concerning new antiplatelet drugs in patients with stable coronary artery disease as well as a gap in the understanding about the use of new antiplatelet drugs used in combination with anticoagulation treatment.

Source 2016 European guidelines for cardiovascular disease prevention

Third sector agencies such as the European Heart Network (EHN) play an important role in providing education around clinical data and its interpretation. The EHN’s mission statement is;

“The European Heart Network plays a leading role in the prevention and reduction of cardiovascular diseases, in particular heart disease and stroke, through advocacy, networking, capacity- building and patient support, so that they are no longer a major cause of premature death and disability throughout Europe.”

The EHN’s vision is that;

“Every European has a right to a life free from avoidable cardiovascular diseases.”

One of their objectives in order to achieve this vision is;

  • Gathering and disseminating information relevant to heart health promotion and cardiovascular disease prevention.

The European Stroke Organisation (ESO) aims to

“improve stroke care by providing medical education to healthcare professionals and the lay public. By offering best practice approaches, the ESO’s goal is to harmonise stroke management in Europe. ESO works as the voice of stroke in Europe to bring about political change. The ESO focuses on European level projects while working towards global solutions.”

And is therefore a useful source of information around stroke prevention and management.

Primary prevention of cancer

To be developed if guidelines on chemoprevention become available.