Aspirin Therapy: Should You or Shouldn’t You?

Discover the risks and benefits of aspirin therapy

Aspirin therapy

You may be tempted to run out and buy baby aspirin after hearing that low-dose aspirin therapy lowers risks of cancer along with risks of heart attack and stroke.

But don’t start for the drugstore just yet. Get your doctor’s blessing. Aspirin therapy may not be right for you.

Cleveland Clinic internist Steven E. Feinleib, MD, of the Preventive Medicine Department, says doctors will consider:

  • Whether you have a family history of heart disease
  • Whether you have a family history of cancer and, if so, which type
  • Your age
  • Your cardiovascular risk factors
  • Your other medications

Protection against heart disease and stroke

Aspirin therapy has long been praised for its ability to prevent heart attack and stroke. Aspirin is a potent blood thinner that keeps clots from forming in the arteries supplying the heart and brain.

But reports later surfaced that taking just 75 milligrams — less than one baby aspirin — per day increased the risk of stomach bleeds (gastrointestinal bleeding).

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So the U.S. Preventive Services Task Force recommends aspirin therapy only if the benefits of cardiovascular protection outweigh the risks of GI bleeding for:

  • Men ages 45 to 79, for heart attack prevention
  • Women ages 55 to 79, for stroke prevention

Protection against cancer

In March 2012, Oxford University researchers analyzing a large number of studies reported additional benefits:

  • Regular aspirin use reduced long-term risks of developing colorectal, esophageal and breast cancers.
  • Taking daily aspirin for at least three years lowered the incidence of cancer nearly 25 percent among men and women.
  • Taking daily aspirin for at least five years reduced the risk of death from cancer 37 percent.
  • Aspirin therapy reduced the risk of local cancers spreading 74 percent. After six and a half years, the risk of distant cancers spreading fell 36 percent.
  • Deaths from solid cancers fell 35 percent with daily aspirin use.

Risk of stomach bleeding

It‘s hard to imagine any risk that could outweigh those benefits. But aspirin, like other nonsteroidal anti-inflammatory drugs (NSAIDs), is hard on the stomach. People with arthritis and other age-related ailments use NSAIDS more often and for longer periods. This increases their risk of peptic ulcers (affecting the stomach or digestive tract). Because clot formation is compromised, bleeding may not stop when an ulcer perforates the stomach.

One person in 833 taking low-dose aspirin and one person in 250 taking high-dose aspirin is at risk of GI bleeding, and some episodes are life-threatening. The older you are, the greater your risk.

“The doses of aspirin needed for cancer prevention, if valid, have not been established. They may be much higher than the low-dose aspirin therapy used for cardiovascular protection, which could increase risk of bleeding,” notes Dr. Feinleib.

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Risk of brain bleeding

While aspirin therapy helps to prevent strokes caused by clots in arteries supplying the brain, it worsens strokes caused by rupture of the arteries supplying the brain. Clotting difficulties can cause irreparable harm from these hemorrhagic strokes.

The Oxford researchers’ analyses hint that bleeding risks from aspirin therapy may diminish over time. However, they say randomized scientific studies on daily aspirin therapy are urgently needed.

The bottom line: Talk to your doctor before starting aspirin therapy. “Make sure you disclose all medications to your healthcare providers, especially over-the-counter medications or supplements,” says Dr. Feinleib. “NSAIDs such as ibuprofen and naproxen can increase risk for gastrointestinal bleeding. Prescribed medications, such as warfarin, Pradaxa® (dabigatran) and Plavix® (clopidogrel), will also increase bleeding risk.”

In the meantime, if you are taking daily aspirin for cardiovascular protection, don’t stop. Stopping aspirin therapy even for a short while can increase your risk of a heart attack up to 60 percent.

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  • Dhowie

    Q  Will taking Advil consistently have the same effects as Aspirin? 

    • Health Hub Team

      No, aspirin has a different anti-inflammatory and cardiovascular effect than other NSAIDs, such as ibuprofen. Research into the unique aspects of aspirin is currently ongoing in the Cleveland Clinic Lerner Research Institute. And unfortunately, taking aspirin and ibuprofen at the same time can increase the risk of gastrointestinal bleeding. —Steven E. Feinleib, MD

  • Lpnlmt14450

    Is it safe to take aspirin on a daily basis if I am also taking omega 3 fish oil?

    • Health Hub Team

      Fish oil may increase the antiplatelet effects of aspirin to a minor degree. This may have a stronger interaction with high doses of fish oil. Check with your doctor if you take higher doses of fish oil before considering taking aspirin. — Steven E. Feinleib, MD

  • Rose

    A friend of ours took for the last 12 years Aspirin Protec and he had suddenly a severe bleeing of the indestines, and  with all the tecnology they could not find the cause. He was in the hospital whe he entered in shock.So they safed his life. But Carlos Fuentes a writer was not so fortunate, he also took Aspirin for a long time and had severe bleeding from above and below and he died . So I gess is is not as safe as they say and it should be realy investigated.Doctors always  say this was not the cause without realy investigating. And they give almost everybody this treatment, with or without risk. They gave Aspirin also to his wife, but she had severe bruises on her arms and she never took it again, as if she would be on warfarin.


    the aspirin anti cougolant effect keeps for one week  are u have researche about it if we take just 75mg asprin weekly we cane get all af pervening rple of aspirin or not i wish send anser of this question

  • Chenbaozhen1980

    my father died suddenly .on the day he died,he felt a little short of breath and a little chest pain ,he had CT -chest scan  ECG echo of heart,but evrything was almost normal。he had Asprin for about 5 months because of his dizziness ,but he stopped eating Asprin by himself for about one week before his death.his past medical history : dizziness for about 1year,no other abnomal,but he smoked( 20/d,30years) and drunk(30 yeas*0.2liter/day).I  wonder whether his death is related with stopping Asprin,i am lookiing forward to your answers.thanks

    • Health Hub Team

      So sorry to hear about your father.  It is very difficult to assess specific cases in this format or even to evaluate cases in retrospect in any situation. — Steven E. Feinleib, MD

  • Jeff

    I recently heard that the risk of bleeding in the brain from aspirin therapy decreases over time. Is there any truth to this? Thank you.