Aspirin Continues to Attract Research and Debate, 115 Years After Its Synthesis

Acetylsalicylic acid, synthesized in an industrial environment in 1897, was introduced to the market as AspirinW in 1899. For about 70 years it represented the mainstay of analgesic/antiinflammatory drug therapy and its pharmacologic actions provided the template for the synthesis of novel nonsteroidal antiinflammatory drugs. Following several fundamental discoveries on its mechanism of action as an antiplatelet drug in the seventies, aspirin has lived a second life as an antithrombotic agent, becoming a fundamental component of cardiovascular prevention and treatment. 1 Making the jump from a largely over-the-counter analgesic remedy to a life-saving prescription drug represents a success story of independent translational research. Key components of success were: a) mechanistic insight into the way in which aspirin inhibits platelet function; b) careful studies of the clinical pharmacology of its antiplatelet effect, establishing the unusual requirements of low dose and long dosing interval for optimal platelet inhibition; and c) a large number of adequately sized, placebo-controlled clinical trials to demonstrate its efficacy and safety in a variety of clinical settings characterized by high cardiovascular risk.2