An Asprin a Day

Aspirin is one of the oldest drugs still in use today and one of the most commonly prescribed drugs for a variety of health conditions. One of the most common questions I hear is “Doctor, should I be taking an aspirin a day?”

Aspirin interferes with your body’s natural ability to clot. Usually clotting is helpful – for example if you accidentally cut yourself with a knife. However, your blood’s clotting cells (platelets) can also clot in the blood vessels that supply your heart and brain and may lead to heart attack or stroke. Aspirin can prevent the clumping of platelets, possibly preventing heart attack and stroke.

Most people know that it is generally a good idea to take an aspirin as soon as a heart attack is suspected. The FDA reports that two 81-mg tablets of aspirin taken when a heart attack is suspected and for thirty days afterward can reduce the risk of death by up to 23 percent. People who have already had a heart attack or who suffer from unstable angina can also benefit from aspirin therapy. In this group, daily aspirin reduced the risk of a heart attack by 30-50 percent. In addition, people with blockage in their coronary arteries who have not had a heart attack are also at high-risk for having a first heart attack and can benefit from aspirin therapy.

With regard to stroke prevention, the FDA recommends regular aspirin use to prevent a stroke in people who have had a TIA (transient ischemic attack) or mini-stroke. For both heart attacks and stroke, if aspirin is being taken for prevention purposes, it can also lessen the damaging effects if a heart attack or stroke does occur. The FDA suggests that aspirin being taken for heart attack and stroke prevention can be taken at low doses – between 75 and 325 mg per day.

If you have strong risk factors, but have not had a heart attack or stroke, you may still benefit from daily aspirin. Some of the risk factors that might influence your doctor to recommend daily aspirin include male sex, family history of heart attack or stroke, older age, being a smoker, high blood pressure, high cholesterol, and diabetes.

Even if you have several risk factors that might influence your decision to take aspirin, you may place yourself in greater danger by adding aspirin to your regimen. Mixing an anticoagulant like warfarin or Coumadin with aspirin might make your blood too thin and increase your risk of bleeding. Complications of taking aspirin might include hemorrhage stroke (bleeding into your brain), gastrointestinal bleeding, allergic reaction, and ringing in the ears and hearing loss.

In addition, if you take aspirin, you should avoid drinking alcohol because of its additional blood-thinning effects. Ibuprofen or naprosyn can counteract the benefits of daily aspirin but if it’s needed only occasionally can be taken two hours after the aspirin. If you need the ibuprofen or naprosyn more than once a week, talk to your doctor about alternatives.

Dr. McMahon, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny County and Pennsylvania Medical Societies. She is in solo practice in the North Hills of Pittsburgh.