An updated meta-analysis of newer RCTs seems to settle the matter as to whether to use aspirin in individuals with no known history of atherosclerotic CVD. PRACTICE CHANGER: Do not routinely use aspirin for primary prevention of cardiovascular disease (CVD). There is no identifiable mortality benefit for those without established CVD--regardless of risk factors. And aspirin therapy increases the risk of major bleeding. STRENGTH OF RECOMMENDATION: Based on a meta-analysis of 11 randomized trials involving 157,248 patients who received aspirin for primary prevention
