Dr. Jacqueline Gerhart: Talk To Your Doctor About Daily Aspirin
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that usually appears weekly on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: My dad takes an aspirin every day for his heart. How does that work? Should I do that too?
Dear Reader: When to use aspirin can get confusing. Let's discuss how aspirin works, what conditions you should use it for, and when to use it to help prevent things like heart attack or stroke.
Aspirin was first marketed by Bayer in 1897. It was first used as a pain reliever. Then in 1918 it was widely used in the Spanish flu pandemic. While it was thought to "cure the flu," it in reality helped simply to reduce the fever. Today, aspirin is used as an analgesic (for pain relief), an antipyretic (for fever reduction) and an anti-inflammatory.
Aspirin's uses go beyond pain and fever, however. Aspirin also works by preventing blood clots. It inhibits our clot-making cells (called platelets) from binding together. Because of this, aspirin is used as a preventive medication in people who may be at high risk of forming clots. People more likely to form clots in their arteries are also more likely to be subject to stroke or heart attack. Therefore, in some populations, taking a daily aspirin can help prevent heart attack or stroke. This is called primary prevention. Aspirin also is used on a daily basis by people who have had a prior heart attack or stroke to help decrease the likelihood that they will have another episode of heart attack or stroke in the future. This is called secondary prevention.
For primary prevention, the United States Preventive Task Force recommends that men aged 45-79 who do not have heart disease take a daily aspirin to prevent a heart attack. Women aged 55-79 should take a daily aspirin to prevent stroke. Interestingly, the opposite is not true: Studies did not show that men had a decreased risk of stroke or that women had a decreased risk of heart attack while on aspirin for primary prevention.
For patients who already had a heart attack or stroke, or who had a stent or bypass surgery, a daily aspirin or other anti-platelet medication may be warranted regardless of age. Have a discussion with your doctor about the benefits of preventing future clots compared to the risks of causing harm from aspirin – like stomach irritation or ulceration.
In addition to prevention, aspirin is actually used at the time of a heart attack. If you have chest pain and call the ER or an ambulance, when you arrive they will give you aspirin. This is because during a heart attack, the arteries of the heart are often clogged and injured – and aspirin helps prevent clot formation in that injured, already narrowed artery – thus potentially lessening damage.
While taking aspirin at the start of a heart attack is recommended, taking aspirin during a stroke is not. While many strokes are caused by clots, some are caused by bleeding blood vessels. Taking aspirin in a situation where you could be bleeding in your brain is dangerous.
You should not take aspirin if you are allergic to it, or to other non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen or naproxen. If you have had prior stomach bleeding or ulcers, aspirin is often not recommended. And, prior to surgery, you will likely be asked to discontinue your daily aspirin for a period of time – usually 5-10 days. Discuss with your doctor the benefits and risks to see if a daily aspirin is right for you.
Thanks for the question!
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 05/28/2014