[Weight-dependent dosing of aspirin; the pharmacological and cardiological perspective]

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A recent meta-analysis by Rothwell and colleagues, presented in The Lancet, of studies using aspirin as primary prevention showed that the effectiveness of the medication was weight-dependent. We discuss the results from both a pharmacological and cardiological perspective to assess the conclusions of this study. The observed result in the meta-analysis could possibly be explained by applying pharmacological principles; however, from a cardiological point of view the extent to which it has an influence on clinical practice is questionable. Notably, the included studies were conducted relatively long ago and results are, therefore, difficult to translate to a more contemporary population; furthermore, it is important to note that in current cardiology practice aspirin is not indicated as primary prevention. Nonetheless, given the complex interaction between patient-related factors and medication in the current population with multiple comorbidities, the present study provides food for thought regarding personalization of therapy.