Is an aspirin a day right for everyone?
Aspirin has been around since 1899, when Bayer patented its first product, and most people now don’t think twice about popping a couple when they are not feeling well.
In the early 1970’s, researchers discovered that a low dose of aspirin could possibly prevent a second heart attack in at-risk patients and a series of trials began. Now it is such common knowledge that a low dose of 75 to 81 milligram can prevent heart attacks, that many people take them without talking to their doctors.
Aspirin works to break up the blood clots that cause heart attacks and strokes because it is a platelet inhibitor, explained John Guerin, MD, a cardiologist at The Cardiovascular Specialists in Falmouth. Clots begin to form when blood platelets start to adhere to each other. Aspirin makes the platelets less “sticky” and blocks enzymes in the blood that can trigger the formation of a clot.
But, aspirin therapy is not for everyone and even the low doses can cause problems, he said.
“I have patients ask me this question every day because it used to be we would say everyone should take an aspirin because the risk is so low,” he said “The risk is low, but it’s not zero. Someone might develop a cerebral hemorrhage from an aspirin.”
Other complications could include bruising, spontaneous bleeding and irritation or bleeding in the stomach. People who take blood thinners or other clot-preventing medications should not take it unless their doctor advises them to do so, he said.
Assessing The Risk
“If a patient has a lot of risk factors, I would be in favor of using aspirin therapy, because the benefits would outweigh the risks,” Dr. Guerin said. “But if you don’t have a lot of risks, then we would weigh the risks against the benefits and they might not add up.”
Doctors assess the risk of maintenance aspirin in the same way they assess the risk of statins for cholesterol control. They look at the traditional risk factors and the patient’s age. For example, Dr. Guerin said that a male who is over 45, smokes and has a family history of heart disease would be a good candidate for a daily low-dose of aspirin because his risks of heart disease are worse than his risks of bleeding.
But, a 25-year-old with no risk factors wouldn’t get as much benefit, and so therefore he would only be exposed to the risks. Those who are older than 70 are also in a different risk-versus-benefit category.
“The risk of coronary heart disease becomes more prevalent with age,” Dr. Guerin said. “You have to review the pros and cons of aspirin therapy to decide on treatment.”
That said, doctors still recommend that anyone who suspects they are having a heart attack chew a full strength 325 milligram aspirin and tuck the pieces under their tongue so it can immediately get into their blood stream.
“The first thing EMTs do if you call an ambulance is they give you an aspirin, if they suspect it’s a heart attack,” Dr. Guerin said. “It can be lifesaving.”
To help people assess their aspirin benefits versus risks, researchers at Brigham and Women’s Hospital and Harvard Medical School developed a free app for iPhones and iPads called “Aspirin Guide.”
You can download the app, answer the questions and then discuss the results with your doctor to determine whether aspirin therapy is right for you.