Hila Asham
1 
, Ahmad Separham
2, Mohammad Javad Kamali
1, Musab Hama Faraj
1, Mehdi Maleki
2, Maryam Mehrpooya
3, Parvin Sarbakhsh
4, Taher Entezari-Maleki
1,2* 1 Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
2 Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3 Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
4 Department of Statistics and Epidemiology, Faculty of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
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.