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  • Alan Frischer, MD, MPH

Aspirin

Taking a daily aspirin may lower the risk of heart attack and stroke, but is it appropriate for everyone? There are days when you just don’t want to read this entire column, so here is the answer: NO.


What does an old-fashioned aspirin do for us? Taking an occasional aspirin or two is safe for most adults, and can be useful for treating pain, fever, and headaches. Aspirin affects our body in another very important way. When we bleed, clotting cells (platelets) collect at the site. Platelets help form a plug that seals the opening in the blood vessel, which stops the bleeding. Clotting can even occur within our heart or brain vessels, and this sometimes leads to a heart attack or stroke. Aspirin reduces this clotting action.

As we age, the risk of heart attack and stroke tends to increase. However, the risk of gastrointestinal bleeding from aspirin rises even more. Those at higher risk for heart attack or stroke will receive more benefit than harm from a daily aspirin, but taking a daily aspirin does not benefit those who already have a low risk of heart attack or stroke. Here are guidelines to follow:


People who should NOT take a daily aspirin include those:

  • without known heart or vascular disease

  • without significant risk factors for heart disease or stroke

  • with bleeding or clotting disorders

  • with an aspirin allergy

  • with a history of bleeding ulcers or other gastrointestinal bleeding

  • already taking non-steroidal anti-inflammatory drugs

  • already on some blood thinning medication, including NSAIDs, or other blood thinning medications specifically given for atrial fibrillation, deep vein thrombosis or pulmonary embolism.

People who might benefit from a daily aspirin include those:

  • who have heart disease, including those who have had coronary bypass surgery or a stent placed in an artery

  • between 40 and 60 who are at high risk of heart disease due to underlying diseases (such as diabetes), along with another risk factor: high cholesterol, smoking, hypertension, or a family history of heart disease.


If you have been taking a daily aspirin, is it safe to stop? If you have a heart attack or a stent placed in one or more heart arteries, then it’s important to continue taking daily aspirin exactly as directed by your doctor. Stopping daily aspirin therapy can have a rebound effect that could trigger a blood clot and lead to a heart attack.


Coated aspirin was designed to be gentler on the stomach by passing through the stomach and not dissolving until it reaches the small intestine. However, there is no evidence that it actually decreases the chance of developing gastrointestinal bleeding, and due to absorption issues, it may not work as well as plain aspirin.


If you are considering taking a daily aspirin or have started taking it on your own, I urge you to speak with your doctor. Together you can evaluate your own particular set of health issues, and weigh the advantages and disadvantages of aspirin.

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