Acetylsalicylic Acid (Aspirin): Past, Present, and Future
Nejra Kovacevic, Dzenan Beciragic , Mirsada Causevic
1 Sarajevo Medical School, University Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
Corresponding Author: Corresponding Author: Dr Mirsada Causevic, PhD, Sarajevo Medical School, University Sarajevo School of Science and Technology, Hrasnicka cesta 3a, Sarajevo 71000, Bosnia and Herzegovina; E-mail: mirsada.causevic@ ssst.edu.ba; Phone: +387 33 975-001; ORCID ID: 0000-0002-6099-6415.
Cite this article: Kovacevic N, Beciragic D, Causevic M. Acetylsalicylic Acid (Aspirin): Past, Present, and Future.
Sar Med J. 2024; 1(2): Online ahead of print. 
10.70119/0015-24
Pages: 92-104 / Published online: 02 December 2024
Original submission: 15 September 2024; Revised submission: 07 November 2024; Accepted: 27 November 2024
Abstract
Acetylsalicylic acid is the most common antithrombotic drug, which started its pharmacolo-gical journey as a non-steroidal, anti-infl ammatory drug. When used as a low-dose drug (of 75-100mg) once per day, it irreversibly inhibits prostaglandin H synthase, commonly termed cyclooxygenase 1 or COX-1 enzyme, which is acetylsalicylic acid’s molecular drug target in human platelets. This mechanism of action ensures that the inhibition of the pro-aggregatory prostanoid – thromboxane A2 synthesis is achieved permanently in platelets throughout their lifespan, which is responsible for acetylsalicylic acid’s antithrombotic eff ect. In this literatu-re review, we provide an overview of acetylsalicylic acid’s development through history, the current understanding of the molecular mechanism of its action, as well as the resulting side eff ects impacting diff erent tissues due to its control of the arachidonic acid metabolism and prostanoid synthesis in them. In an eff ort to begin a dialogue regarding the evidence in favor of unresponsiveness to acetylsalicylic acid’s therapeutic eff ect in specifi c patients, we describe already identifi ed molecular mechanisms of resistance to acetylsalicylic acid and list the existing biomarkers which are able to quantifi ably measure the achieved degree of acetylsalicylic acid’s clinical effi cacy. Furthermore, we look to the future by encouraging a personalized approach to acetylsalicylic acid’s use in order to maximize its therapeutic eff ect and its safety. Moreover, we mention the ongoing clinical trials evaluating the role of acetylsalicylic acid in prevention of colorectal and other cancers.
Keywords: Acetylsalicylic Acid, Aspirin, Cyclooxygenase Inhibitors, Prostaglandin Endoperoxide Synthase Inhibitors, Platelet Aggregation Inhibitors, Antithrombotic Agents.
