President Trump says he takes a daily adult aspirin. Should you?

President Donald Trump recently said he takes a daily adult aspirin (325 mg) to thin his blood, despite medical advice that he should take a lower dose. That raises the question: What do doctors say about using aspirin for cardiovascular health, especially older people? President Trump is 79.

Aspirin does have its benefits and can be a lifesaver if someone is having symptoms of a heart attack, according to Hyannis cardiologist  Andrew J. Wall, MD, FACC.

“A one-time full-strength aspirin (325 mg), chewed, should be taken right away—unless there’s a known allergy or active bleeding. This helps stop clot formation quickly and has been shown to reduce death during a heart attack. Afterward, most patients are switched to a lower daily dose,” Dr. Wall said.

To clarify, aspirin is not a true “blood thinner,” he said.  

“True blood thinners, like Eliquis, Xarelto and warfarin, work on a coagulation cascade. Aspirin is a platelet inhibitor, preventing platelets from clumping together, which reduces clot formation.”  

While aspirin can be helpful if someone is actively having a heart attack, the advice on aspirin use for prevention of cardiovascular disease differs and falls into two categories, said Dr. Wall. The categories are:

• Primary prevention, for people who have not had a cardiovascular event, such as a heart attack or stroke.
• Secondary prevention, for people who had a cardiovascular event or have cardiovascular disease, such as coronary artery disease or peripheral artery disease. Plaque accumulating on interior arterial walls causes both of these conditions, which limits blood flow to the affected areas, according to the American Heart Association.

A low-dose, or baby aspirin (81-100 mg) may be given for primary prevention to people between the ages of 40 and 70 in some cases and is generally not given to people older than 70 because of the risk of bleeding and stroke, Dr. Wall said.

“Even in people who are considered high risk — for example, those with multiple risk factors like high blood pressure, diabetes, high cholesterol, or smoking — daily aspirin is not automatically recommended,” he said. “According to national cardiology guidelines: Low-dose aspirin may be considered in adults between 40 and 70 years old only if their heart risk is high and their risk of bleeding is low.”

Secondary Prevention

Advice differs for secondary prevention.

“If you’ve had a heart attack, a stroke caused by a blood clot, or have coronary artery disease or peripheral artery disease, then daily low-dose aspirin is usually recommended long-term, unless there’s a specific reason you can’t take it. In these patients, aspirin clearly lowers the risk of another heart attack or stroke, and the benefits strongly outweigh the risks,” said Dr. Wall.

That includes secondary prevention for people over 70, he continued, though another blood thinner, Plavix (clopidogrel) might be prescribed instead of low-dose aspirin.

“More emerging data that the bleeding risk may be lower with long-term Plavix after stent (implantation of a spring-like device to prop open an artery) than long-term (daily low-dose aspirin), but it’s one or the other, that data is not in the guidelines yet,” he said.

Medical advice on aspirin for cardiovascular disease prevention changed in 2022, when the U.S. Preventive Services Task Force updated its 2016 recommendations. Prior to the task force’s updated recommendations, and similar guidelines issued in 2019 by the American College of Cardiology and the American Heart Association, daily low-dose aspirin use was seen as fairly harmless.

Bleeding Risk

President Trump acknowledged his use of adult-strength aspirin has caused bruising, visible on his right hand, according to a Jan. 1 CNN article on the Wall Street Journal interview.

Aspirin use and advanced age both raise the risk of bleeding.

“As we get older, the risk of serious bleeding from aspirin increases, especially bleeding in the stomach or brain. That’s why people over 70 are generally advised not to start aspirin for primary prevention, even if their heart risk is elevated,” Dr. Wall said.

Occasional Aspirin Use OK

Aspirin can still be used for occasional pain relief, such as headaches, muscle aches, tooth pain, or fever—but it should not be used casually or long-term, especially in older adults, said Dr. Wall.

“While aspirin isn’t off-limits for pain, it’s not the safest first choice for most people, particularly those over 60,” he said.

For pain or fever, aspirin should be used only occasionally at the lowest effective dose, for short periods — typically a few days, not weeks, he added.

“If someone feels they need pain medication regularly or daily, that’s a sign they should talk to a doctor rather than continue aspirin on their own. Daily aspirin should not be used for chronic pain, and it should never be started long-term without medical guidance,” he continued.

For pain or fever, especially in older adults, acetaminophen (Tylenol) is usually the first choice, because it does not increase bleeding risk. Dr. Wall cautioned that staying within recommended dosing is important to protect your liver.