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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 and stroke, but daily aspirin therapy isn't for everyone. Is it right for you?

You should consider daily aspirin therapy only if you've had a heart attack or stroke, or you have a high risk of either. And then, only take aspirin with your doctor's approval. 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 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, 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 and brain 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 can burst. Then, a blood clot can quickly form and 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 platelets — possibly preventing heart attack and stroke.

Does daily aspirin therapy differ between men and women?

Aspirin can have different effects between the sexes, and for women, among age groups.

For men of all ages, aspirin can:

  • Prevent a first and second heart attack
  • Reduce heart disease risk

For women younger than 65, aspirin can:

  • Prevent a first stroke
  • Prevent a second heart attack
  • Reduce heart disease risk

For women 65 and older, aspirin can:

  • Prevent a first and second heart attack
  • Prevent a first stroke
  • Reduce heart disease risk

The risk of bleeding with daily aspirin therapy, however, is about the same in both sexes.

Should you take a daily aspirin?

Whether you need daily aspirin therapy depends on your risk of heart disease and stroke. Risk factors for a heart attack or stroke include:

  • Smoking tobacco
  • High blood pressure — a systolic pressure of 140 millimeters of mercury (mm Hg) or higher or a diastolic pressure of 90 mm Hg or higher
  • Total cholesterol level of 240 milligrams per deciliter (mg/dL) — 6.22 millimoles per liter (mmol/L) — or higher
  • Low-density lipoprotein ("bad") cholesterol level of 130 mg/dL (3.37 mmol/L) or higher
  • Lack of exercise
  • Diabetes
  • Stress
  • Having more than two alcoholic drinks a day for men, one drink a day for women
  • Family history of a stroke or heart attack

If you've had a heart attack or stroke, chances are your doctor has talked to you about taking aspirin to prevent a second occurrence.

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. First, you'll want to discuss with your doctor whether you have any conditions that make taking aspirin dangerous for you.

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

You shouldn't take a daily aspirin if you have some health conditions that could increase your risk of bleeding or other complications. These conditions include:

  • A bleeding or clotting disorder (bleeding easily)
  • Asthma
  • Stomach ulcers
  • Heart failure

For people who have diabetes, the American Diabetes Association and other medical associations recommend a low-dose aspirin only for men older than 50 and women older than 60 who have at least one additional risk factor for heart disease, such as smoking, family history of heart disease, high cholesterol or high blood pressure.

It's also important to tell your doctor what other medications or supplements you might be taking, even if it's just ibuprofen (Advil, Motrin, others). Taking aspirin and ibuprofen together reduces the beneficial effects of the aspirin. Taking aspirin with other anticoagulants, such as warfarin (Coumadin), could greatly increase your chance of bleeding.

What's the best dose of aspirin to take?

There's no uniform dose of aspirin you should take to get the benefits of daily aspirin therapy. You and 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 may prescribe a daily dose anywhere from 81 mg — the amount in a baby aspirin — to 325 mg (regular strength).

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 or stroke. 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 could have a rebound effect that may trigger a blood clot.

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References
  1. U.S. Preventive Services Task Force. Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine. 2009;150:396.
  2. Hennekens CH. Benefits and risks of aspirin in secondary and primary prevention of cardiovascular disease. http://www.uptodate.com/home/index.html. Accessed Jan. 12, 2010.
  3. Campbell CL, et al. Aspirin dose for the prevention of cardiovascular disease: A systematic review. Journal of the American Medical Association. 2007;297:2018.
  4. Berger JS, et al. Aspirin for the primary prevention of cardiovascular events in women and men. Journal of the American Medical Association. 2006;295:306.
  5. 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 Jan. 5, 2010.
  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. Aspirin drug interactions. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed Jan. 12, 2010.
  8. Eisenstein EL, et al. Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. Journal of the American Medical Association. 2007;297:159.
  9. Walker J, et al. Does enteric-coated aspirin result in a lower incidence of gastrointestinal complications compared to normal aspirin? Interactive Cardiovascular and Thoracic Surgery. 2007;6:519.
  10. Aspirin. Lexi-Interact. Lexi-Comp. http://www.uptodate.com/crlsql/interact/frameset.jsp. Accessed Jan. 12, 2010.
  11. 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.
  12. Pignone M, et al. Aspirin for primary prevention of cardiovascular disease in people with diabetes. Circulation. 2010; In press. Accessed June 7, 2010.
HB00073 June 17, 2010

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