# Aspirin loading in coronary artery disease patients already taking aspirin: A systematic review

## TL;DR

This systematic review finds that reloading aspirin in coronary artery disease patients already taking it may improve cardiovascular outcomes without significant risks.

## Contribution

The study provides the first systematic review on the effects of aspirin reloading in CAD patients already on aspirin therapy.

## Key findings

- Aspirin reloading significantly reduces thromboxane B2 levels in CAD patients.
- Aspirin reloading improves platelet reactivity and myocardial injury indexes.
- No significant adverse effects like bleeding or increased mortality were observed.

## Abstract

Aspirin is considered a cornerstone medication among patients with established coronary artery disease (CAD). There is a lack of evidence regarding aspirin reloading in CAD patients who are already receiving aspirin therapy. We performed this systematic review to address this gap of knowledge. A systematic review on PubMed, Embase, and the Cochrane Library was conducted from inception until July 15, 2024. Two authors independently performed study selection, data extraction, and risk of bias assessment. Means differences (MD) were used in a meta-analysis of related outcomes from the studies. Our review included four studies enrolling 1187 individuals with CAD and chronic aspirin use before admission. The results of this systematic review found that aspirin reloading is significantly associated with a reduction of thromboxane B2 (MD, -17.46; 95% CI, -19.61 to -15.32; P<0.00001; I2=0%). Additionally, our findings revealed the beneficial effects of aspirin loading on thromboxane B2 -related platelet reactivity and myocardial injury indexes. No significant adverse outcomes, such as bleeding and increased mortality, were observed among the study groups. In conclusion, aspirin reloading can improve cardiovascular outcomes with a good safety profile among CAD individuals. However, further randomized clinical trials (RCTs) are still needed to provide robust evidence.