Low-Dose Aspirin Use in Primary Care Pharmacotherapeutic Risk Profiles and Factors Associated with Deprescribing

Abstract

Background: The changing benefit–risk profile of low-dose aspirin, particularly in primary cardiovascular prevention, requires periodic reassessment of long-term therapy in primary care. This study evaluated real-world aspirin pharmacotherapy, potentially inappropriate use, pharmacotherapeutic risk, and factors associated with deprescribing. Methods: This retrospective observational study included 4668 patients receiving aspirin 100 mg in primary care from January 2020 to August 2026. Clinical characteristics, prevention strategy, treatment initiation, concomitant pharmacotherapy, bleeding-related risk factors, documented adverse events during aspirin therapy, and therapeutic decisions were evaluated. Potentially inappropriate aspirin use was characterized descriptively according to documented clinical and pharmacotherapeutic information, while multivariable logistic regression was used to identify factors independently associated with documented aspirin discontinuation (deprescribing). Results: Potentially inappropriate aspirin use was identified in 25.9% of patients and was markedly more frequent in primary than secondary prevention (52.3% vs. 1.8%; p < 0.001). Compared with patients classified as having appropriate use, those with potentially inappropriate use were older (70.0 vs. 64.7 years) and more frequently received oral anticoagulants (21.3% vs. 6.5%) and had polypharmacy (57.5% vs. 50.1%), previous gastrointestinal bleeding (7.5% vs. 2.7%), and concomitant NSAID exposure (15.6% vs. 12.3%). At least one documented adverse event during aspirin therapy occurred in 28.8% of patients. Aspirin was discontinued in 8.5%, while 5.1% required further benefit–risk reassessment. Documented discontinuation (deprescribing) was independently associated with primary prevention (aOR 1.83, 95% CI 1.30–2.56), potentially inappropriate use (aOR 4.05, 95% CI 2.94–5.58), documented adverse events during aspirin therapy (aOR 3.61, 95% CI 2.87–4.53), and previous gastrointestinal bleeding (aOR 4.38, 95% CI 2.96–6.47). Conclusions: Potentially inappropriate low-dose aspirin use was concentrated in primary prevention and was characterized by a distinct clinical and pharmacotherapeutic risk profile. Documented aspirin discontinuation was associated with several clinically relevant benefit–risk signals, including potentially inappropriate use, documented adverse events during aspirin therapy, previous gastrointestinal bleeding, and primary-prevention use. Structured reassessment of indication, bleeding history, concomitant medications, and adverse effects may help identify patients requiring individualized aspirin deprescribing.