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Daily aspirin therapy: Understand the benefits and risks

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 before considering daily aspirin therapy.

By Mayo Clinic staff

Daily aspirin therapy may lower your risk of heart attack, but daily aspirin therapy isn't for everyone. Is it right for you?

You should take a daily aspirin only if your doctor advises you to do so. If you have had a heart attack or stroke, your doctor will likely recommend you take a daily aspirin unless you have a serious allergy or history of bleeding. If you have a high risk of having a first heart attack, your doctor might recommend aspirin after weighing the risks and benefits. You shouldn't start daily aspirin therapy on your own.

Although taking an occasional aspirin or two is safe for most adults to use for headaches, body aches or fever, daily use of aspirin can have serious side effects, including internal bleeding.

How can aspirin prevent a heart attack?

Aspirin interferes with your blood's clotting action. When you bleed, your blood's clotting cells, called platelets, build up at the site of your wound. The platelets help form a plug that seals the opening in your blood vessel to stop bleeding.

But this clotting can also happen within the vessels that supply your heart with blood. If your blood vessels are already narrowed from atherosclerosis — the buildup of fatty deposits in your arteries — a fatty deposit in your vessel lining can burst. Then, a blood clot can quickly form and block the artery. This prevents blood flow to the heart and causes a heart attack. Aspirin therapy reduces the clumping action of platelets — possibly preventing a heart attack.

Should you take a daily aspirin?

You shouldn't start daily aspirin therapy on your own in an effort to prevent a heart attack. Your doctor may suggest daily aspirin therapy if:

  • You've already had a heart attack or stroke
  • You haven't had a heart attack, but you have had a stent placed in a coronary artery, have had coronary bypass surgery, or you have chest pain due to coronary artery disease (angina)
  • You've never had a heart attack, but you're at high risk of having one
  • You're a man with diabetes older than 50, or a woman with diabetes older than 60

Although aspirin has been recommended in the past for certain groups of people without a history of heart attack, there's some disagreement among doctors about this approach. Guidelines are changing and have varied between organizations. The bottom line is that before taking a daily aspirin you should have a discussion with your doctor.

Should you avoid daily aspirin therapy if you have another health condition?

Before starting daily aspirin therapy under the advice of your doctor, you should let him or her know if you have a health condition that could increase your risk of bleeding or other complications. These conditions include:

  • A bleeding or clotting disorder (bleeding easily)
  • Aspirin allergy, which can include asthma caused by aspirin
  • Bleeding stomach ulcers

What's the best dose of aspirin to take?

Your doctor will discuss what dose is right for you. Very low doses of aspirin — 75 milligrams (mg), which is less than a standard baby aspirin — can be effective. Your doctor will usually prescribe a daily dose anywhere from 81 mg — the amount in a baby aspirin — to 325 mg (a regular strength tablet). If you have had a heart attack or have had a heart stent placed, it is very important to take aspirin and any other blood thinning medications exactly as recommended.

What happens if you stop taking aspirin every day?

You might be surprised to learn that stopping daily aspirin therapy can have a rebound effect that may increase your risk of heart attack. If you have had a heart attack or a stent placed in one or more of your heart arteries, stopping daily aspirin therapy can lead to a life-threatening heart attack. If you've been taking daily aspirin therapy and want to stop, it's important to talk to your doctor before making any changes. Suddenly stopping daily aspirin therapy could have a rebound effect that may trigger a blood clot.

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References
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  2. Aspirin and heart disease. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HeartAttack/PreventionTreatmentofHeartAttack/Aspirin-and-Heart-Disease_UCM_321714_Article.jsp. Accessed March 8, 2012.
  3. Hennekens CH. Benefits and risks of aspirin in secondary and primary prevention of cardiovascular disease. http://www.uptodate.com/home/index. Accessed March 8, 2012.
  4. Pignone M, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes. Journal of the American College of Cardiology. 2010;55:2878.
  5. Seshasia SRK, et al. Effect of aspirin on vascular and nonvascular outcomes: Meta-analysis of randomized controlled trials. Archives of Internal Medicine. 2012;172:209.
  6. ACCF/ACG/AHA Writing Committee Members, et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. Circulation. 2008;118:1894.
  7. Huang ES, et al. Long-term use of aspirin and the risk of gastrointestinal bleeding. American Journal of Medicine. 2011;124:456.
  8. Information for healthcare professionals: Concomitant use of ibuprofen and aspirin. U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm125222.htm. Accessed March 8, 2012.
  9. Aspirin. Lexi-Interact. Lexi-Comp. http://www.uptodate.com/crlsql/interact/frameset.jsp. Accessed March 8, 2012.
  10. Aspirin drug interactions. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed March 9, 2012.
  11. Wright RS, et al. 2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients with Unstable Angina/ Non-ST-Elevation Myocardial Infarction (Updating the 2007 Guideline): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;123:2022.
  12. Antithrombotic Trialists' (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: Collaborative meta-analysis of individual participant data from randomised trials. The Lancet. 2009;373:1849.
  13. Hirata Y, et al. Incidence of gastrointestinal bleeding in patients with cardiovascular disease: Buffered aspirin versus enteric-coated aspirin. Scandinavian Journal of Gastroenterology. 2011;46:803.
  14. Eagle KA, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: Summary article — A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2004;110:1168.
HB00073 April 6, 2012

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