Daily aspirin therapy: Understand the benefits and risks

Taking aspirin every day may lower the risk of heart attack and stroke. But daily aspirin therapy isn't for everyone. Is it right for you?

The answer depends on your age, overall health, history of heart disease, and risk of heart attack or stroke.

Daily aspirin therapy may be used in two ways:

• Primary prevention. This means that you've never had a heart attack or stroke. You've never had coronary bypass surgery or coronary angioplasty with stent placement. You've never had blocked arteries in your neck, legs or other parts of the body. But you take a daily aspirin to prevent such heart events. The benefit of aspirin for this use has been debated.
• Secondary prevention. This means that you had a heart attack or stroke, or you have known heart or blood vessel disease. You're taking a daily aspirin to prevent a heart attack or stroke. The benefit of daily aspirin therapy in this situation is well established.

Don't start taking a daily aspirin without talking with your healthcare professional. For most adults, it's usually safe to take an occasional aspirin or two for headaches, body aches or fever. But taking aspirin every day can have serious side effects, including bleeding in the gastrointestinal tract. The gastrointestinal tract includes the mouth, throat, esophagus, stomach, intestines, rectum and anus.

Talk with your healthcare team about the pros and cons of daily aspirin therapy. Together you can discuss whether an aspirin a day might help you prevent a heart attack or stroke.

The risk of heart attack and stroke goes up as you get older. But the risk of bleeding from aspirin goes up even more. So:

• In people who have a low risk of heart attack, the benefits of taking a daily aspirin don't outweigh the risks of bleeding.
• The higher the risk of heart attack, the more likely it is that the benefits of daily aspirin therapy are greater than the bleeding risks.

Because of bleeding risks, some guidelines say that people age 60 and older without known heart or blood vessel disease should not start taking a daily aspirin to prevent a first-time heart attack or stroke. But guidelines vary among organizations. Other recommendations say you should not take a daily aspirin after age 70.

If you're between ages 60 and 69, ask your healthcare professional how daily aspirin therapy may affect you.

Daily low-dose aspirin therapy may be recommended for the primary prevention of heart attack or stroke if:

• You are 40 to 59 years old and have a high risk of having a heart attack or stroke for the first time within the next 10 years. High risk means your risk is 10% or greater.
• You never had a heart attack, but you've had coronary artery bypass graft surgery or a stent placed in a heart artery. Or you have chest pain called angina or another medical condition where aspirin is proved to prevent heart attacks or strokes.
• You are younger than 60 and you have diabetes and at least one other heart disease risk factor. Heart disease risk factors include smoking and high blood pressure.

If you've had a heart attack or stroke or you have known heart disease, your healthcare professional may tell you to take an aspirin a day to prevent heart attacks or strokes. You should not take a daily aspirin if you have a serious aspirin allergy or history of bleeding.

Aspirin thins the blood and helps prevent blood clots. Sometimes clots happen inside a heart artery. The clot slows or stops blood flow to the heart. This can cause a heart attack. The buildup of fats, cholesterol, and other substances in and on the artery walls, a condition called atherosclerosis, increases the risk of blood clots in the heart arteries.

Since aspirin prevents blood clots, it's thought that daily aspirin therapy could possibly prevent a heart attack.

Take a daily aspirin only if your healthcare professional tells you to do so. Before starting daily aspirin therapy, tell your healthcare team about all the health conditions you have.

Daily aspirin therapy may not be a good choice if you have:

• A bleeding or clotting disorder that makes you to bleed easily.
• An aspirin allergy, which can include asthma caused by aspirin.
• Bleeding stomach ulcers or a history of gastrointestinal bleeding.

You and your healthcare professional can talk about what aspirin dose is right for you. Low doses of aspirin — about 75 to 100 milligrams (mg), but most commonly 81 mg — can help prevent heart attack or stroke. The daily dose for aspirin therapy is usually between 75 mg and 325 mg.

If you are on daily aspirin therapy, do not stop taking aspirin until you talk with your healthcare professional.

Stopping daily aspirin therapy suddenly may trigger a blood clot and lead to a heart attack.

Always tell your healthcare team about all the medicines you take, including those bought without a prescription.

Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin IB, Advil, others) and naproxen sodium (Aleve), can thin the blood. This makes it hard for blood to clot. Regular use of ibuprofen and naproxen sodium can increase the risk of bleeding. Taking aspirin with some NSAIDs can increase the risk of bleeding even more.

Some NSAIDs also increase the risk of heart attacks. If you have a reason to use low-dose aspirin — such as a history of a heart attack or bypass surgery — NSAIDs cannot be used instead of aspirin to prevent heart attacks.

Aspirin, ibuprofen and naproxen sodium also may cause stomach ulcers. The risk of ulcers goes up a lot if you take aspirin and one of these other medicines together.

If you need to take ibuprofen or similar medicines, talk with your healthcare professional about options that won't interfere with daily aspirin therapy. For example, acetaminophen (Tylenol, others) may be an option.

Side effects and complications of taking daily aspirin include:

• Stroke caused by a burst blood vessel. While daily aspirin can help prevent a clot-related stroke, it may increase the risk of a bleeding stroke. A bleeding stroke also is called a hemorrhagic stroke.
• Gastrointestinal bleeding. Daily aspirin use increases the risk of developing a stomach ulcer. If you already have a bleeding ulcer or gastrointestinal bleeding, taking aspirin may cause more bleeding. The bleeding may be life-threatening.
• Allergic reaction. If you're allergic to aspirin, taking any dose of aspirin can trigger a serious allergic reaction.

If you're taking aspirin and you need surgery or dental work, tell the healthcare professional. You and your healthcare team may need to take steps to prevent excessive bleeding. Don't stop taking a daily aspirin without talking to the healthcare professional that prescribed it.

Sometimes, a healthcare professional might recommend combining low-dose aspirin with a prescription blood thinner. Such combination therapy always needs to be carefully discussed. The combination may greatly increase the risk of major bleeding.

Prescription blood thinners include:

• Apixaban (Eliquis).
• Dabigatran (Pradaxa).
• Enoxaparin (Lovenox).
• Heparin.
• Rivaroxaban (Xarelto).
• Warfarin (Jantoven).

Other medicines that can interact with aspirin and may increase bleeding risks include:

• Clopidogrel (Plavix).
• Corticosteroids.
• Ibuprofen (Advil, Motrin IB, others), when taken regularly.
• Some antidepressants, such as clomipramine (Anafranil) and paroxetine (Paxil, Brisdelle).

Some herbal and dietary supplements also can increase the bleeding risk when combined with aspirin. These include:

• Bilberry.
• Capsaicin.
• Cat's-claw.
• Danshen.
• Evening primrose oil.
• Ginkgo.
• Kava.
• Ma-huang.
• Omega-3 fatty acids (fish oil).

Drinking alcohol while on daily aspirin therapy may increase the risk of stomach bleeding. Talk with your healthcare professional about how much alcohol is safe to drink. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.

Yes. Taking aspirin during a heart attack is safe and recommended. If you think you're having a heart attack, call 911 or your local emergency number right away. Aspirin alone won't save your life if you're having a heart attack.

When you call for help, the emergency operator may tell you to chew an aspirin. The operator first asks if you have an aspirin allergy or other health condition that would make taking an aspirin unsafe. It's OK to chew an aspirin if your healthcare professional has previously told you to do so if you think you're having a heart attack. But always call 911 or emergency medical help first.

Coated aspirin also is called enteric-coated aspirin. It is made to pass through the stomach and not dissolve until it reaches the small intestine. Coated aspirin may be gentler on the stomach. It may be appropriate for some people who take a daily aspirin, especially those with a history of gastrointestinal inflammation or ulcers.

But there's no evidence that taking coated aspirin lowers the risk of gastrointestinal bleeding. Also, coated aspirin may not work as well as plain aspirin when taken at the time of a possible heart attack. Talk with your healthcare professional if you're concerned about your bleeding risk.