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  » Medical Topic Archive  »  Daily aspirin therapy

Daily aspirin therapy

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 first.

Daily aspirin therapy helps lower the risk of heart attack and clot-related strokes, but it's not appropriate for everyone. Is it right for you? Only if you've had a heart attack or stroke, or you're at high risk of either, should you consider daily aspirin therapy. And then, proceed only with your doctor's approval. Although taking an occasional aspirin or two is safe for most adults to use for head and body aches or fever, daily use of aspirin can have serious side effects. For healthy people who are already at low risk of heart attack or stroke, the risks of aspirin therapy may outweigh the benefits. However, for people who are at risk, especially those who have already had a heart attack or stroke, an aspirin a day could be lifesaving.

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 cut or wound. The platelets normally form a sticky plug that seals the opening in your blood vessel to stop bleeding. However, blood can also clot within the blood vessels that supply your heart and brain with blood. If blood vessels are already narrowed from accumulation of fatty deposits, a blood clot can quickly 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 your platelets — possibly preventing heart attack and stroke.

Does 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 do indeed differ between the sexes. Aspirin appears to be more effective at preventing a first stroke in women than in men, but more effective in preventing a first heart attack in men than in women. The risk of bleeding, however, is near equal 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.

Do I need to take aspirin?

Whether you need daily aspirin therapy depends on your risk of heart disease and stroke. If you've had a heart attack or stroke, chances are your doctor has talked to you about taking aspirin to prevent a second event — this is referred to as secondary prevention. 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 actually increase your risk of heart attack or stroke.

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. Preventing a first heart attack or stroke is called primary prevention and may be a good strategy for people at high risk of these events. First, you'll want to discuss with your doctor whether you have any conditions that make taking aspirin dangerous for you. For example, if you bleed easily, have a stomach ulcer or even have asthma, aspirin may not be safe for you. If you have heart failure, aspirin may reduce the effectiveness of some of your medications, so this is another area to discuss with your doctor. You'll also need to know how much you should take, and when. 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 could be dangerous.

Weighing your risk of heart attack and stroke

In deciding, along with your doctor, if you're a good candidate for daily aspirin therapy, it's important to be aware of all of your risk factors for heart disease and stroke.

The major risk factors for heart attack and stroke are:

  • Sex. Men are at greater risk of heart attacks and stroke than women are, until women reach the age of 65, after which the risk is similar.
  • Family history of heart disease or stroke. A history of early heart disease in a parent or sibling places you at higher risk.
  • Age. The older you get, the greater your risk.
  • Smoking status. Smoking is one of the top risk factors for cardiovascular disease.
  • High blood pressure. Uncontrolled high blood pressure increases your risk of heart attack and stroke. It also reduces the effectiveness of aspirin therapy.
  • High cholesterol. High cholesterol, particularly a high low-density lipoprotein (LDL) level and a low high-density lipoprotein (HDL) level, contributes to the risk.
  • Diabetes. People who have diabetes are at higher risk of heart disease and stroke.

If you have any of these risk factors, talk to your doctor about whether you're a candidate for daily aspirin therapy.

Weighing your risk of bleeding and other complications

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 might make your blood too thin, thus increasing the risk of major bleeding complications. 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 are taking, before beginning daily aspirin therapy.

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 also 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 shouldn't drink alcohol because of its additive blood-thinning effects.

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 impair the protective effect of aspirin. Occasional use of ibuprofen — less than 60 days a year — doesn't seem to impair the ability of aspirin to reduce the risk of heart attack.

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

How much aspirin should I take?

The jury is still out on the best dose of aspirin to prevent heart attack and stroke. Some studies suggest that lower doses work as well as full-strength doses. Your doctor may prescribe a daily dose anywhere from 81 milligrams (mg) — the amount in a baby aspirin — to 325 mg (regular strength).

What happens if I stop taking aspirin every day?

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 can have a rebound effect that may trigger a blood clot, causing further complications.

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 or swallowing a plain regular-strength 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. Emergency personnel will assess after imaging whether a stroke is related to a clot or to bleeding, and they can give aspirin at that time if appropriate.

Should I take a coated aspirin?

Enteric-coated aspirin is designed to pass through your stomach and not disintegrate until it reaches your intestines. As such, it's less erosive to 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. Also, it doesn't appear to offer significant protection against gastrointestinal bleeding. In addition, some research suggests that enteric-coated aspirin may actually be less potent than plain aspirin. So, a dose of enteric-coated aspirin could have less beneficial effect on blood than an equivalent dose of plain aspirin has.

More studies are needed to better understand the therapeutic differences between plain aspirin and enteric-coated aspirin. If you have questions or concerns about the type of aspirin you take, consult 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 and so can be used along with aspirin for some people who need extra clot-reducing power.

This class of drugs includes clopidogrel (Plavix), eptifibatide (Integrilin) and others. These medications may be used:

  • During a heart attack or clot-related strokes
  • Before and after angioplasty to help reduce surgery-related blood clots
  • To treat peripheral vascular disease

Superaspirin may be an option if you're resistant to aspirin (meaning you don't get the clot-preventing benefits) or can't tolerate its side effects.

Aspirin — Tried and true

With all of the amazing medical advances and new medications available, it's reassuring to know that good old 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, or any new drug

By Mayo Clinic staff

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