Aspirin Deprescribing Interventions for Primary Prevention: A Systematic Review and Proposed Guidance for Deprescribing

Recent literature indicates that the benefits of aspirin use for primary prevention of atherosclerotic cardiovascular disease (ASCVD) may be equivocal to the risk. This has resulted in several organizations making updates to their clinical practice guidance on appropriate use. Despite this narrower scope, specific guidance on how to deprescribe aspirin in patients already on therapy for primary prevention is lacking. The purpose of this paper is two-fold: to provide a systematic review of the literature on aspirin deprescribing strategies and propose a practical aspirin deprescribing algorithm when used discordantly with current recommendations for primary prevention. We conducted searches in databases including EMBASE, PubMed, Web of Science, Scopus, and CINAHL from January 2018 to March 2025. One hundred and sixty-seven studies were screened, and 13 articles were included. The studies utilized a variety of interventions to impact aspirin deprescribing. In each of the studies included, there was at least some type of prompt to trigger deprescribing aspirin. However, a consistent approach was not defined. A multidisciplinary model occurred in half of the studies included, which resulted in the highest reported deprescribing rate of 78%. However, there were limited descriptions of patient-related outcomes as a result of deprescribing, warranting additional studies. A deprescribing algorithm can assist in guiding aspirin deprescribing for primary prevention of ASCVD while considering patient preferences in an individually tailored approach.