Context

Dual antiplatelet therapy with aspirin and clopidogrel has evolved to form the basis for early treatment of acute coronary syndromes (ACSs). Although initiating aspirin and clopidogrel effectively decreases adverse cardiovascular (CV) events, it also increases the risk of major bleeding. As ischaemic and bleeding complications are strongly related to mortality, it is of paramount importance to maximise efficacy (inhibit thrombotic events) and minimise toxicity (bleeding events).

Most patients presenting with ACS undergo percutaneous coronary intervention (PCI) and therefore require antiplatelet regimens with rapid onset and of sufficient intensity. Since clopidogrel has a slow onset of action and wide variability, it has been suggested that a higher loading and maintenance dose is beneficial in reducing CV events.1 The optimal aspirin dose for the prevention of vascular events has been the subject of much debate.2 Most studies comparing the dose effect of aspirin noted increased bleeding complications with higher doses while observing no differences in efficacy.2 3 However, there is little randomised data in the setting of ACS, and guidelines support the use of higher dose aspirin in the setting of PCI for at …