HEALTH MATTERS: An aspirin a day ... is not for everyoneQ. It seems that many of my friends take a daily baby aspirin. I don’t, but should I?
By: Dr. Joshua Wynne,
Q. It seems that many of my friends take a daily baby aspirin. I don’t, but should I?
A. Let’s first review why people might take an aspirin. Aspirin reduces the ability of the blood to clot by interfering with the function of special cells called platelets that circulate in the blood. When platelets clump together, they can form clots; these clots are beneficial if they occur after injury because the clot stops the blood flow in the area of injury. But clots can be bad when they occur in people with heart or vascular disease, because they can clog an artery, limit the blood supply, and result in a heart attack or stroke.
The use of an aspirin (in a dose of one baby aspirin up to one adult aspirin per day) can reduce the risk of subsequent blood clots in three main situations — people with diseased heart (coronary) arteries; people with diseased blood vessels going to the brain; and people with a certain type of irregular heart beat called atrial fibrillation.
There is no question aspirin use is helpful for people who have experienced heart or vascular problems, or atrial fibrillation. We call this use of aspirin “secondary prevention,” which means we’re treating a patient who has a known disease in an effort to prevent recurrent problems.
The story is altogether different in people who have no manifest heart or vascular disease, but who take an aspirin to try to prevent a first event. This use — primary prevention — is quite controversial, because the benefit (in preventing heart attacks, strokes and death) is quite modest, and the risk (mainly bleeding) is real. In fact, there is no consensus in the medical field that the small benefits of taking aspirin for primary prevention are worth the risk.
So, unless you have known coronary or vascular disease or atrial fibrillation, I’m not at all sure that you should join your friends for a daily dose of aspirin. But this tough question is best answered by visiting with your primary care provider.
Q. Just how much bleeding risk comes with taking a daily aspirin?
A. A recently completed study from Italy looked at the risk of bleeding from low-dose aspirin (less than an adult dose of 325 mg per day) in more than 370,000 people. The study found aspirin use increased the risk of bleeding by about half.
The good news, though, was the overall risk actually was relatively small, about two extra bleeding events for every 1,000 patients taking aspirin per year. In most cases, the excess risk of bleeding was either into the intestinal tract or in the brain. This study found the risk of internal bleeding with aspirin use was about five times higher than we had thought previously.
So, what’s the bottom line? Aspirin is a real drug that has real side-effects. It has important benefits (see above), but it can cause serious bleeding. So, I’d recommend that anyone contemplating chronic aspirin use discuss their own risk-benefit balance with their health care provider before starting. Better safe than sorry!
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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