Aspirin: past, present and future

Many folk remedies used since prehistoric times have depended upon salicyla tes for their effect. One hundred years ago aspirin was formulated from sal icylic and acetic acids. It was the first drug to be synthesised and its fo rmulation is regarded as the foundation of the modern pharmaceutical indust ry. The benefit of low-dose aspirin as a prophylactic after a thrombotic event was first reported 25 years ago. Its use after coronary or cerebral thrombo sis is virtually mandatory, unless there are signs of intolerance. A 'loadi ng dose' of soluble aspirin should be given on first contact with a patient who may be suffering from myocardial infarction. Patients considered to be at increased risk of a vascular event should also be advised to carry thei r own aspirin and, if they experience sudden severe chest pain, to chew and swallow a 300mg tablet or a soluble preparation immediately. The current phase of the aspirin story is, however, not over, and its possi ble value in a variety of conditions, including dementia and certain cancer s, seems likely to ensure that it will long continue to play a remarkable p art in clinical practice.