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Aspirin is not contraindicated in people with a history of coronary artery disease or stroke because it provides a proven antiplatelet effect that helps prevent recurrent cardiovascular events. By irreversibly inhibiting COX-1 in platelets, aspirin reduces thromboxane A2, leading to decreased platelet aggregation. This makes low-dose aspirin a standard part of secondary prevention for CAD and stroke.

In contrast, indomethacin, ibuprofen, and naproxen are NSAIDs that can raise the risk of heart attack or stroke in at-risk patients and may interfere with aspirin’s antiplatelet effect (especially if taken together). They can also worsen blood pressure and fluid retention, which is undesirable in those with cardiovascular disease. Thus, these NSAIDs are generally avoided or used with caution in this population.