The ability of aspirin to inhibit platelet aggregation has positioned this agent within the most frequently used drugs worldwide. The aim of this article is to review the contemporary clinical use of aspirin and also to discuss unresolved issues not yet translated into clinical practice. Results from several clinical trials have led to strong guideline recommendations for aspirin use in the acute management and secondary prevention of cardiovascular disease. On the contrary, guidelines regarding aspirin use as primary prevention of cardiovascular disease are almost conservative, supported by recent trials reporting that the bleeding risk outweighs the potential benefits in most patients. In pregnancy, aspirin has proved efficient in preventing preeclampsia and small-for-gestational-age births in women at high risk, and is hence widely recommended in clinical guidelines. Despite the vast amount of clinical data on aspirin, several unresolved questions remain. Randomized trials have reported that aspirin reduces the risk of recurrent venous thromboembolism, but the clinical relevance remains limited, because direct oral anticoagulants are more effective. Laboratory studies suggest that a twice-daily dosing regimen or evening intake may lead to more efficient platelet inhibition, and the potential clinical benefit of such strategies is currently being explored in ongoing clinical trials. Enteric-coated formulations of aspirin are frequently used, but it remains unclear if they are safer and as efficient as plain aspirin. In the future, aspirin use after percutaneous coronary interventions might not be mandatory in patients who also need anticoagulant therapy, as several trials support shorter aspirin duration strategies. On the other hand, new treatment indications for aspirin will likely arise, as there is growing evidence that aspirin may reduce the risk of colorectal cancer and other types of cancer.

阿司匹林抑制血小板聚集的能力使这种药物成为世界上最常用的药物。本文的目的是回顾阿司匹林的当代临床应用，并讨论尚未转化为临床实践的未解决问题。几项临床试验的结果为阿司匹林用于心血管疾病的急性管理和二级预防提供了强有力的指导建议。相反，关于使用阿司匹林作为心血管疾病一级预防的指南几乎是保守的，最近的试验表明出血风险超过了大多数患者的潜在益处。在怀孕期间，阿司匹林已被证明可有效预防高危女性的先兆子痫和小于胎龄儿的分娩，因此在临床指南中被广泛推荐。尽管有大量关于阿司匹林的临床数据，但仍有几个未解决的问题。随机试验报告说，阿司匹林可降低复发性静脉血栓栓塞的风险，但临床相关性仍然有限，因为直接口服抗凝剂更有效。实验室研究表明，每天两次给药方案或晚上摄入可能会导致更有效的血小板抑制，目前正在进行的临床试验正在探索这种策略的潜在临床益处。阿司匹林的肠溶包衣制剂经常使用，但尚不清楚它们是否比普通阿司匹林更安全、更有效。将来，对于还需要抗凝治疗的患者，经皮冠状动脉介入治疗后使用阿司匹林可能不是强制性的，因为一些试验支持较短的阿司匹林持续时间策略。另一方面，阿司匹林可能会出现新的治疗适应症，因为越来越多的证据表明阿司匹林可以降低结直肠癌和其他类型癌症的风险。