European Guidelines for Aspirin

April 2018

The purpose of this document is to keep a working list of European guidelines with information on aspirin.

The European Heart Journal has published 2016 European guidelines on cardiovascular disease prevention in clinical practice.  These guidelines have been developed by a task force put together by the European Society of Cardiology (ESC) and include representation from:

  • European Association for Cardiovascular Prevention and Rehabilitation (EACPR)  
  • European Association for the Study of Diabetes (EASD)
  • European Association of Cardiovascular Imaging (EACVI)
  • European Association of Percutaneous Cardiovascular Interventions (EAPCI)
  • Heart Failure Association (HFA)
  • Council on Cardiovascular Nursing and Allied Professions
  • Council for Cardiology Practice
  • Council on Cardiovascular Primary Care
  • European Atherosclerosis Society (EAS)
  • European Heart Network (EHN)
  • European Society of Hypertension (ESH)
  • European Stroke Organisation (ESO)
  • International Diabetes Federation European Region (IDF Europe)
  • International Federation of Sports Medicine (FIMS)
  • International Society of Behavioural Medicine (ISBM)
  • WONCA (World Organization of Family Doctors) Europe

They use the following classifications to grade their evidence.

The following categories of recommendation statements are used;

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.” 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 guidelines state that the results of four major primary prevention trials;

•          Two in patients with diabetes mellitus (ASCEND, ACCEPT-D)

•          One in individuals of advanced age (ASPREE)

•          One in individuals with moderate CV risk (ARRIVE)

are anticipated over the next 5 years. This may alter the current recommendations.

Secon​​​​dary prevention of cardiovascular disease

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 colorectal cancer/all GI cancers

European Cancer Prevention (ECP) and its journal the European Journal of Cancer Prevention (EJCP) have an interest in the role of aspirin and cancer prevention. In their journal they state;

“chemoprevention has a relevant role for reducing risk of selected cancer sites, particularly of the colorectum and of hormone-related sites. This field (again, from cells to rodents, to clinical trials, to populations) has substantially developed over the last two decades, and continuum attention has been given to it by the EJCP)  www.ecpo.org/?page_id=12

EuropaColon is:

“committed to preventing deaths from colorectal cancer and improving the quality of life and support for those affected by the disease.”

EuropaColon has a number of news articles about aspirin and cancer prevention.

Role o​​​​f aspirin in delaying the spread of cancer

EuropaColon (see above) has a news article regarding aspirin and cancer recurrence and survival.