[Acetylsalicylic acid in the prevention and treatment of cardiovascular diseases].

Acetylsalicylic acid (ASA) is one of the most popular medicines in the world. ASA preparations have been used for over 100 years as anti-inflammatory, antipyretic and analgesic drugs. Since 1971, ASA has also been used as an antiplatelet drug. The main antiplatelet effect of aspirin is the irreversible inhibition of the key enzyme of arachidonic acid cascade, a prostaglandin H synthetase, also called cyclooxygenase (COX). ASA is a widely used drug in the prevention of cardiovascular diseases. In accordance with the current European guidelines, ASA is indicated in secondary prevention in all patients with established cardiovascular disease (coronary heart disease, previous myocardial infarction, previous stroke, peripheral atherosclerosis). Life therapy with low doses (75-150 mg daily) is recommended. ASA is also used to treat acute myocardial infarction, unstable coronary heart disease, coronary artery bypass surgery and angioplasty, as well as to treat acute stroke. Despite the proven benefits, approximately 10-20% of patients taking ASA are at risk for re-occurring cardiovascular events. In connection with the above, the phenomenon of the so-called resistance to ASA (or high on treatment platelet reactivity despite ASA). This phenomenon was reported in patients after stroke (up to 60% of subjects), in atherosclerosis of the lower limbs (up to 60%), in stable coronary disease (up to 70%) and in patients immediately after myocardial infarction (up to 80%). Despite studies conducted for several years, so far there are no clear guidelines for monitoring platelet function in patients taking ASA, both in primary and secondary stroke prevention.