Daily aspirin therapy: Understand the benefits and risks

Daily aspirin therapy: Understand the benefits and risks

Is an aspirin a day the right thing for you? It's not as easy a decision as it sounds. Know the benefits and risks before considering daily aspirin therapy.
Daily aspirin therapy helps lower the risk of heart attack and stroke, but daily aspirin therapy isn't appropriate for everyone. Is it right for you?

You should consider daily aspirin therapy only if you've had a heart attack or stroke, or you're at high risk of either. And then, proceed only with your doctor's approval. Although taking an occasional aspirin or two is safe for most adults to use for headaches, body aches or fever, daily use of aspirin can have serious side effects.

How does aspirin prevent a heart attack or stroke?
Aspirin interferes with your blood's clotting action. When you bleed, your blood's clotting cells, called platelets, accumulate at the site of your wound. The platelets help form a plug that seals the opening in your blood vessel to stop bleeding.

But this clotting can also happen within the vessels that supply your heart and brain with blood. If your blood vessels are already narrowed from atherosclerosis — the accumulation of fatty deposits in your arteries — a blood clot can quickly form and block the artery. This prevents blood flow to the heart or brain and causes a heart attack or stroke. Aspirin therapy reduces the clumping action of platelets — possibly preventing heart attack and stroke.


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Does daily aspirin therapy differ between men and women?
Early studies on daily aspirin therapy were done mostly in men. More recent studies have focused on the effects of aspirin in women, finding that its effects differ between the sexes, and for women, between age groups. The table below shows how aspirin can affect men and women differently.

Aspirin benefits for men and women

A daily aspirin can: Women under age 65 Women age 65 and older Men (all ages)
Prevent first stroke X X
Prevent first heart attack X X
Reduce heart disease risk X X X
Prevent second heart attack X X X

The risk of bleeding with daily aspirin therapy, however, is about the same in both sexes. More study is needed to determine how or if this might change recommendations for daily aspirin therapy for heart attack and stroke prevention.

Should I take a daily aspirin?
Whether you need daily aspirin therapy depends on your risk of heart disease and stroke. Risk factors for a heart attack or stroke include:

Smoking tobacco
High blood pressure — a systolic pressure of 140 millimeters of mercury (mm Hg) or higher or a diastolic pressure of 90 mm Hg or higher
Total cholesterol level of 240 mg/dL (6.22 mmol/L) or higher
Low-density lipoprotein ("bad") cholesterol level of 130 mg/dL (3.68 mmol/L) or higher
Lack of exercise
Diabetes
Stress
Having more than two alcoholic drinks a day for men, one drink a day for women
Family history of a stroke or heart attack
If you've had a heart attack or stroke, chances are your doctor has talked to you about taking aspirin to prevent a second occurrence.

If you have strong risk factors, but have not had a heart attack or stroke, you may also benefit from taking an aspirin every day. First, you'll want to discuss with your doctor whether you have any conditions that make taking aspirin dangerous for you.

Some conditions that may prevent you from starting daily aspirin therapy include:

A bleeding or clotting disorder (bleeding easily)
Asthma
Stomach ulcers
Heart failure
It's also important to tell your doctor what other medications or supplements you might be taking, even if it's just ibuprofen. Taking aspirin and ibuprofen together reduces the beneficial effects of the aspirin. Taking aspirin with other anticoagulants, such as warfarin (Coumadin) could greatly increase your chance of bleeding.


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What's the best dose of aspirin to take?
There's no uniform dose of aspirin you should take to get the benefits of daily aspirin therapy. You and your doctor will discuss what dose is right for you. Some studies have shown that very low doses of aspirin — 75 milligrams (mg), which is less than a standard baby aspirin — can be effective. Your doctor may prescribe a daily dose anywhere from 81 mg — the amount in a baby aspirin — to 325 mg (regular strength).

What happens if I stop taking aspirin every day?
While you might know that taking daily aspirin helps prevent additional heart attacks or strokes, you might be surprised to learn that stopping daily aspirin therapy can have a rebound effect that may increase your risk of heart attack or stroke. If you've been on daily aspirin therapy and want to stop, it's important to talk to your doctor before making any changes. Suddenly stopping daily aspirin therapy could have a rebound effect that may trigger a blood clot.

Can I take aspirin if I regularly take ibuprofen for another condition?
Ibuprofen counteracts the benefit of daily aspirin therapy when taken together. Both aspirin and ibuprofen reduce the clotting action of blood platelets.

Aspirin is still effective if taken two hours before a single daily dose of ibuprofen. However, taking multiple doses of ibuprofen daily or taking ibuprofen before aspirin can prevent aspirin from working effectively. Occasional use of ibuprofen — less than 60 days a year — is usually OK.

If you need only a single dose of ibuprofen, take it eight hours before or 30 minutes after the aspirin. If you need to take ibuprofen more often, talk to your doctor about medication alternatives.

What are the possible side effects of daily aspirin therapy?
Even if you do have risk factors for heart attack or stroke, don't pop open your aspirin bottle just yet. If you're already taking an anticoagulant such as warfarin (Coumadin) for another condition, combining it with aspirin may greatly increase the risk of major bleeding complications. However, there may be some conditions for which combining a low dose of aspirin with warfarin is appropriate (for example, with certain types of artificial heart valves for secondary stroke prevention), but this therapy always needs to be carefully discussed with your doctor.

Other medications and herbal supplements also may increase your risk of bleeding. Be sure to talk to your doctor about all of your medications — prescription and over-the-counter — and any supplements that you're taking, before beginning daily aspirin therapy.

Side effects and complications of taking aspirin include:

Hemorrhagic stroke. While daily aspirin can help prevent a clot-related stroke, it may increase your risk of a bleeding stroke (hemorrhagic stroke).
Gastrointestinal bleeding. Daily aspirin use increases your risk of developing a stomach ulcer. And, if you have a bleeding ulcer, taking aspirin will cause it to bleed more, perhaps to a life-threatening extent.
Allergic reaction. If you're allergic to aspirin, taking any amount of aspirin can trigger a serious allergic reaction.
Ringing in the ears (tinnitus) and hearing loss. Too much aspirin (overdosing) can cause tinnitus and eventual hearing loss in some people.
If you're taking aspirin and you must undergo even a simple surgical procedure or dental work, be sure to tell the surgeon or dentist that you take daily aspirin and how much. Otherwise you risk excessive bleeding during surgery.

The Food and Drug Administration also warns that people who regularly take aspirin should limit the amount of alcohol they drink because of its additional blood-thinning effects and potential to upset your stomach. If you take daily aspirin therapy, you should not have more than one drink a day if you're a woman or two drinks a day if you're a man.


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If I take daily aspirin, is it still safe to take an aspirin during a heart attack?
For most people experiencing heart attack symptoms, doctors recommend chewing and swallowing one plain regular-strength aspirin or two to four baby aspirin. This recommendation still holds true if you are on daily aspirin therapy. Chewing the aspirin speeds up the absorption process and minimizes any delay in the beneficial effects of aspirin.

If you have certain bleeding disorders, you should not take an aspirin during a heart attack, and you're also not a candidate for daily aspirin therapy.

Don't take aspirin if you think you're having a stroke, because not all strokes are caused by blood clots; some are caused by ruptured blood vessels. Taking aspirin could make a bleeding stroke more severe.


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Should I take a coated aspirin?
Enteric-coated aspirin is designed to pass through your stomach and not disintegrate until it reaches your intestines. It's gentler on the stomach and may be appropriate for some people who take a daily aspirin, especially in those with a history of gastritis or ulcers.

However, it takes longer for your body to absorb enteric-coated aspirin, and it doesn't appear to offer significant protection against bleeding in your stomach and intestines. More studies are needed to better understand the differences between plain aspirin and enteric-coated aspirin. If you have questions or concerns about the type of aspirin you take, ask your doctor to determine the best option for you.

What is a superaspirin?
Perhaps you've heard or read about what is sometimes called a "superaspirin." Superaspirin refers to a newer class of drugs that are available as an alternative or supplement to aspirin. These medications are called platelet aggregation inhibitors and reduce the risk of blood clots. Though they have similar effects as aspirin, they work by a slightly different action. This class of drugs includes clopidogrel (Plavix), eptifibatide (Integrilin) and others. These medications may be used:

Along with aspirin, to reduce the risk of another heart attack or stroke in people who have had one
During a heart attack or clot-related strokes
Before and after angioplasty and stent placement, to help reduce procedure-related blood clots
To treat peripheral vascular disease
Superaspirin may be an option if you are resistant to aspirin (meaning you don't get the clot-preventing benefits), are allergic to aspirin or can't tolerate its side effects. The combination of aspirin and clopidogrel (Plavix) is recommended only for people who have specific heart or blood vessel conditions. If you are currently taking Plavix and aspirin but have not had a heart attack or stroke, don't stop taking it suddenly. Talk to your doctor first.

Aspirin — Tried and true
With all of the amazing medical advances and new medications available, it's reassuring to know that aspirin is still an effective, affordable and simple option for many people at risk of heart attack and stroke. Though aspirin is readily available, always check with your doctor before starting daily aspirin therapy.


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Reprints and permissions By Mayo Clinic Staff
Feb 27, 2008
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