“An Aspirin A Day … Or Not?”

For over 100 years, aspirin has been known to reduce blood clotting.

I write about aspirin because I continue to encounter a number of patients who take a daily aspirin without a legitimate medical reason for doing so.  Likewise, there are equally as many patients who should be taking a daily aspirin that for some reason are not.

There is now a world-wide recommendation that patients who have had a previous heart attack or stroke or those who have had any type of blood vessel procedure should take a low dose aspirin tablet (80-100mg) daily for the remainder of their lives.  This recommendation includes patients who have been treated for a blood clot in a major vein.   Doctors agree that aspirin reduces the chance of a second cardiovascular event from occurring and in some of these patients aspirin reduces the risk of death.

If a patient cannot take aspirin, then a substitute medication is usually prescribed.

What is more controversial, and still not settled is who should take a daily aspirin if they have NOT had one of these cardiovascular medical events?  While there have been many studies to try to answer this question, the current recommendation on taking aspirin in this setting requires a primary care physician or cardiovascular specialist to determine a specific patient’s risk for future cardiovascular events.  If this evaluation results in telling the patient that the probability of having a heart attack or stroke in the next 10 years is greater than 5%, then low dose daily aspirin is recommended to try to reduce the chance of these events from occurring.  Weighing the modest benefit of aspirin in this setting against the possibility of gastrointestinal or brain bleeding from the drug itself is tricky and requires physician input.  Your physician will consider your blood pressure, weight, family history, exercise habits, history of tobacco use, other medical issues and then use several published risk analysis models to help come up with a recommendation;  for or against aspirin.

Aspirin is a good drug.  Just don’t take it if you won’t benefit from it.  Rely on your primary care physician to guide you on this.  After all, once you begin taking it, it will usually become a life-long therapy.