Minnesota Academy of Family Physicians

Using Aspirin Wisely - When It's Smart and When It's Not
-Patient Education from the Minnesota Academy of Family Physicians-

December 9, 2009

Aspirin, often referred to as the ‘wonder drug’, is one of the most widely used and least expensive medications on the market. In fact, Americans consume an estimated 80 million pills a year. It falls into a drug class called non-steroidal anti-inflammatory drugs or NSAIDs. Typically used to reduce fever or offer relief for minor aches and pains, regular aspirin use is also associated with the prevention of heart attacks and strokes.

According the U.S. Food and Drug Administration, daily aspirin therapy has been shown to help lower the risk of heart attack, clot-related strokes and other blood flow problems. Aspirin works by interfering with the normal way blood clots. When a person bleeds, platelets in the blood form a seal at the opening to stop the bleeding. If this happens within a vessel that supplies blood to the heart and brain, the clot can completely block the flow of blood to these organs causing a heart attack or stroke. Daily aspirin use is believed to prevent this by reducing the build-up of platelets (clotting) in the arteries.

“Daily aspirin therapy does have distinct benefits for many people, but it’s not for everyone,” said James Struve, a family physician with Bloomington Lake Clinic in Minneapolis and a member of the Minnesota Academy of Family Physicians. “Like any drug, aspirin has potential risks. Just because it is available over the counter, doesn’t mean it should be taken regularly without careful consideration.”

Aspirin does have side effects which why it’s important to discuss daily aspirin use with a doctor. Aspirin reduces a patient’s level of stomach protection and increases their risk of having a perforated stomach ulcer or bleeding in the GI tract. It can also increase the risk of a bleeding (hemorrhagic) stroke, tinnitus (ringing in the ears) and even hearing loss. Experts warn that patients taking aspirin need to limit the amount of alcohol they drink because it has additional blood-thinning effects.

Dr. Struve says it’s not uncommon for patients to come across an article praising the benefits of aspirin and then decide to start using it daily. While he and other family physicians are pleased to see patients who are interested in taking charge of their own health, they want to educate consumers that daily aspirin therapy should only be used under the guidance of a trusted doctor.

“It’s important for a physician to determine if the benefits of long-term aspirin use will be greater than the risks,” said Dr. “Struve. “We do this by studying a person’s health history, their current state of health, and by examining other medications being used by the patient.”

Doctors say that patients most likely to benefit from a daily dose of aspirin are those who have a personal or family history of coronary artery disease and/or atrial fibrillation, known cerebrovascular disease, those who are older than 40 and who have multiple risks for the development of heart disease such as high blood pressure, high cholesterol, diabetes, or are a smoker. Recent analysis has shown that daily aspirin therapy may have a better protective effect against stroke in women and against heart attack in men.

Conditions that may prohibit a person from starting daily aspirin therapy include an allergy to aspirin, bleeding or clotting disorder that causes them to bleed easily, stomach ulcers, asthma, heart failure, and the use of other medicines or herbal supplements that might make aspirin use dangerous or ineffective such as anticoagulants or ibuprofen. Another issue that a physician will help with is determining the correct dose of aspirin to take. “In most cases, a baby aspirin dose of 81 milligrams is effective, but sometimes we will recommend more than that,” said Dr. Struve. “There are no directions on the aspirin label for this kind of use, that’s why you need your doctor.”

Additional studies have shown that the benefits of aspirin may go beyond heart attack and stroke prevention. There is evidence that aspirin may slow the progression of colon cancer and even dementia.

“There’s no doubt that aspirin can live up to its ‘wonder’ title for a lot of people,’ added Dr. Struve. “The key to its success is using it wisely under the direction of your family doctor,” said Dr. Struve.