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.
By Mayo Clinic Staff
Daily aspirin therapy may lower your risk of heart attack, but daily aspirin therapy isn't for everyone. Is it right for you?
You should take a daily aspirin only if your doctor advises you to do so. If you have had a heart attack or stroke, your doctor will likely recommend you take a daily aspirin unless you have a serious allergy or history of bleeding. If you have a high risk of having a first heart attack, your doctor might recommend aspirin after weighing the risks and benefits. You shouldn't start daily aspirin therapy on your own.
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, including internal bleeding.
Aspirin interferes with your blood's clotting action. When you bleed, your blood's clotting cells, called platelets, build up 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 with blood. If your blood vessels are already narrowed from atherosclerosis — the buildup of fatty deposits in your arteries — a fatty deposit in your vessel lining can burst. Then, a blood clot can quickly form and block the artery. This prevents blood flow to the heart and causes a heart attack. Aspirin therapy reduces the clumping action of platelets — possibly preventing a heart attack.
You shouldn't start daily aspirin therapy on your own in an effort to prevent a heart attack. Your doctor may suggest daily aspirin therapy if:
- You've already had a heart attack or stroke
- You haven't had a heart attack, but you have had a stent placed in a coronary artery, have had coronary bypass surgery, or you have chest pain due to coronary artery disease (angina)
If you've never had a heart attack, but you're at high risk of having one, the benefit of aspirin therapy is unclear. Clinical studies are ongoing to try to answer the question of aspirin use to prevent heart attacks. In the meantime you should talk to your doctor if you are at high risk.
Before starting daily aspirin therapy under the advice of your doctor, you should let him or her know if you have a health condition that could increase your risk of bleeding or other complications. These conditions include:
- A bleeding or clotting disorder (bleeding easily)
- Aspirin allergy, which can include asthma caused by aspirin
- Bleeding stomach ulcers
Your doctor will discuss what dose is right for you. Very low doses of aspirin — 75 milligrams (mg), which is less than a standard baby aspirin — can be effective. Your doctor will usually prescribe a daily dose anywhere from 81 mg — the amount in a baby aspirin — to 325 mg (a regular strength tablet). If you have had a heart attack or have had a heart stent placed, it is very important to take aspirin and any other blood thinning medications exactly as recommended.
You might be surprised to learn that stopping daily aspirin therapy can have a rebound effect that may increase your risk of heart attack. If you have had a heart attack or a stent placed in one or more of your heart arteries, stopping daily aspirin therapy can lead to a life-threatening heart attack. If you've been taking 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.
Both aspirin and other nonsteroidal anti-inflammatory medications, such as ibuprofen (Motrin, Advil, others) and naproxen (Aleve), reduce the clotting action of blood platelets. Regular use of nonsteroidal anti-inflammatory medications can increase your bleeding risk, as can other medications you may take for aches and pains (Tylenol, others).
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 or other NSAIDs more often, talk to your doctor about medication alternatives that won't interfere with daily aspirin therapy.
Side effects and complications of taking aspirin include:
- Stroke caused by a burst blood vessel. 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 or bleeding anywhere else in your gastrointestinal tract, 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 need a 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 choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.
If you're already taking an anticoagulant, such as warfarin (Coumadin, Jantoven), dabigatran (Pradaxa) or rivaroxaban (Xarelto) 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, such as with 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. Medications that can interact with aspirin include:
- Ibuprofen (Advil, Motrin, others), when taken regularly
- Some antidepressants (clomipramine, paroxetine, others)
Taking some dietary supplements can also increase your bleeding risk. These include:
- Dong quai
- Evening primrose oil
- Omega-3 fatty acids (fish oil)
- Willow bark
If you think you're having a heart attack, the most important thing for you to do is call 911 or emergency medical services. Don't delay calling for help. Aspirin alone won't save your life if you're having a heart attack.
The operator may advise you to chew an aspirin, but will first ask questions to make sure you're not allergic to aspirin or have any other health conditions that would make taking an aspirin during a heart attack too risky. It's OK to chew an aspirin if your doctor has previously told you to do so if you think you're having a heart attack — but call 911 or emergency medical services first.
Enteric-coated aspirin is designed to pass through your stomach and not disintegrate until it reaches your small intestine. 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, some researchers think there's no evidence that taking an enteric-coated aspirin decreases your chance of developing gastrointestinal bleeding. Talk to your doctor if you're concerned about ways to decrease your bleeding risk.
May 20, 2014
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