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aspirin

An Aspirin a Day? Only If You Have Had a Heart Attack

FDA issues recommendation against preventative low doses

If you never have had any cardiovascular problems, the Food and Drug Administration (FDA) says you should not take aspirin to avoid a heart attack or stroke.

In a recommendation issued this week, the FDA says scientists have not proven aspirin therapy has any benefit for people without cardiovascular problems. This group includes those with risk factors such as a family history of heart disease.

At the same time, people taking aspirin every day face serious risks. These risks include developing dangerous bleeding into the stomach or brain.

What if I have an existing heart condition?

If you have heart disease, such as a prior heart attack, bypass surgery or stents, everyone agrees that you should be taking a daily baby aspirin (81 mg) unless your doctor determines that you have a very high bleeding risk. For people without previous heart disease, aspirin is generally not recommended because bleeding in the brain or stomach can occur with daily aspirin use—even if you are taking coated aspirin.

For individual patients, your doctor will be able to calculate your risks and benefits from taking aspirin. Every heart condition is different and every patient’s situation is unique. Your doctor will need to know your medical history and weigh the risks.

Only for a select few 

When you have a heart attack, it’s because one of the coronary arteries, which provide blood to the heart, has developed a clot. The clot obstructs the flow of blood and oxygen to the heart.

Aspirin thins the blood, which makes it less likely to clot. The logic is that taking an aspirin a day helps prevent heart attacks.

Clinical data since the 1990s does show that a daily low dose of aspirin can help prevent a re-occurrence for people who have had a heart attackstroke or disease of the heart’s blood vessels, the FDA says.

But only a select few patients benefit from aspirin therapy – even among those who have had cardiovascular problems.

The patient who would benefit from aspirin therapy is someone who has every risk factor: high blood pressure, high cholesterol, strong family history, diabetes, smoking. Among patients with all of these risk factors, some of them we will treat with aspirin. But it’s not very many.

Bleeding common

Internal bleeding, especially in the stomach, is quite common with daily aspirin use.

So if you have a low risk of a heart attack, the bleeding risk may overwhelm any potential benefit of aspirin.

The recommendation came on the heels of the FDA denying a request from Bayer. The drug manufacturer asked to change its aspirin packaging to say consumers could use aspirin as a prevention measure, even if they have not had a heart attack, stroke or cardiovascular problems.

You should stop taking aspirin if you’re taking it without a doctor’s guidance to prevent cardiovascular problems and have no history of heart disease or heart attack.

Don’t self-medicate

Above all, talk with your doctor.

Frankly, self-medication is almost never a good idea, whether it’s aspirin or anything else.

The FDA recommendation applies to doses ranging from 81 milligrams in a low-dose tablet to the 325 milligrams in a regular-strength tablet.

For patients with a history of cardiovascular problems, the FDA says your doctor should tell you the aspirin dose and frequency that will provide the greatest benefit with the least side effects.

More information

Tags: aspirin, blood clots, heart attack
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  • Duckweed

    My heart doctor recommends that I take the daily 325mg regimen. I have not had a heart attack but have high cholesterol, currently under control through use of a statin.

    • The_Beating_Edge_Team

      Each patient is unique and your doctor may have reasons to put you on aspirin, but given the recent findings and the fact you are on a large dose, you may want to discuss this with him at your next visit. betsyRN

  • Maryanne Wazny

    What if u have documented a-fib? Not giving up my 81mg daily aspirin unless my cardio tells me.

    • GeorgeBMac

      Absolutely do not stop taking it without talking to you physician – but if you have a-fib you should be under very close supervision by a physician and he is probably prescribing some blood thinning medications – and aspirin may be one them.

    • The_Beating_Edge_Team

      Maryanne – patients with atrial fibrillation are at increased risk for stroke. Based on the new atrial fibrillation guidelines (http://content.onlinejacc.org/article.aspx?articleid=1854230), a risk calculator called the CHAD2DS2-VASc Score for patients with atrial fibrillation helps the doctor determine the need for anticoagulation. Do not stop your aspirin without speaking to your doctor. betsyRN

  • GeorgeBMac

    I take 81mg of Aspirin a day. But I got a shock the other day when I nicked my finger but could not stop the bleeding. It wasn’t a big bleed but it still bled for hours. Pressure on the nick was the only thing that would control it. It was kind of scary – my blood simply would not clot up.

    On my finger it was just a nuisance – but if that had been a serious wound or an internal one, I could easily have bled out.

    I immediately stopped taking the Aspirin and will discuss it with my cardiologist when I see him next week.

  • Sis

    What if you are positive for Factor 5?

  • Lee

    I have had colon cancer and my oncologist said there had a been some evidence suggesting that taking 81 mg daily aspirin may help to prevent a recurrence.

  • Downunder

    In Australia, our “standard” aspirin dose is 100mg of coated tablet so that they don’t dissolve until AFTER they have passed the stomach.

  • Luke

    Before you go around telling people to stop taking daily aspirin, because they haven’t had a heart attack or stroke, shouldn’t you consider all the other benefits and risks from taking the daily aspirin.

    The following information was taken from a 2012 article at http://health.usnews.com/health-news/living-well-usn/articles/2012/03/21/14-things-you-might-not-know-about-aspirin-2?page=2.

    PROs for taking aspirin daily.

    Research reported in 2012 suggests that a daily aspirin can slow the spread of or even prevent cancer.

    Three studies published in the 2013 Lancet and Lancet Oncology found that such a regimen might cut your risk of death from various cancers by up to 37 percent.

    A 2010 report based on data from the Nurses’ Health Study suggested that women who had breast cancer and took a low-dose aspirin two to five times weekly were 71 percent less likely to have a deadly recurrence than those who took little or no aspirin.

    A research review published in the Lancet in 2007 suggested that pregnant women who took aspirin or other antiplatelet drugs were 10 percent less likely to develop pre-eclampsia, which involves high blood pressure and potentially serious complications for mother and fetus.

    Research has been inconclusive, but a 2008 review published in Neurology found that people who used aspirin had a 13 percent lower risk of developing Alzheimer’s.

    A 2007 study published in Neurology suggests that women who used aspirin regularly (defined as two or more times a week for at least a month at any point in their lives) may be 40 percent less likely to develop the disease.

    A 2008 study published in Thorax found that women 45 and older who took 100 mg of aspirin every other day were 10 percent less likely to develop asthma over the next decade than women given a placebo. The study authors noted that aspirin could exacerbate symptoms in about 10 percent of people already diagnosed with asthma.

    In 2008, a research review published in the journal BMC Medicine found that earlier studies showed a large benefit in men taking aspirin to reduce the rates of fatal heart attack, but women did not receive the same advantage. A 2009 U.S. Preventive Services Task Force recommendation suggests some women may benefit from aspirin’s action against ischemic strokes, however.

    <<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<

    CONs for taking aspirin daily.

    In a 2008 issue of the journal Cancer, researchers reported that men who used aspirin and other NSAIDs regularly had about 10 percent lower levels of prostate-specific antigens. The researchers suggest this may hinder the detection of prostate cancer in regular aspirin users.

    In 2010, researchers reported in the American Journal of Medicine that regular use of aspirin—at least twice weekly—upped the risk of hearing loss by 12 percent in men. Those younger than 50 had a 33 percent increased risk of hearing loss. Use of other NSAIDss or acetaminophen also increased the risk of hearing loss.

    In 2008, the British Medical Journal published research that suggests diabetics taking aspirin to prevent a first heart attack are no less likely to experience an attack than those taking a placebo. People with diabetes are at least twice as likely to develop heart disease or have a stroke as the general public.

    A 2008 research review published in the British Medical Journal found that nearly 30 percent of people with cardiovascular disease who took prescribed aspirin were resistant to its effects. Such "aspirin resistance," the study found, makes such patients four times as likely as those for whom aspirin had an effect to have a heart attack, stroke, or die.

    People taking aspirin or another NSAID are at higher risk of gastrointestinal bleeding and stomach ulcers—particularly with long-term use of the drug.

    Aspirin makes the blood's platelets less sticky, and the blood less likely to clot. This is especially risky if bleeding occurs in the brain, which can be fatal.

  • Kris

    How about preventative aspirin therapy with a Grade5 PFO?

  • Carol Yoder

    I read a medical article that warns against starting a daily aspirin without a doctor’s recommendation. And, if you decide to stop aspirin therapy all at once, it could actually put you at an immediate higher risk for stroke or heart attack. Should you “ween” yourself off safely? It now sounds risky either way.

    • The_Beating_Edge_Team

      Carol, I spoke to one of our cardiologists. He said since he does not know your history and other risk factors it is hard to say if you should be on the aspirin or come of immediately. This is a good question for your doctor. BetsyRN

  • Chris Weigand

    i HAD A dvt and had to stop coumadin because of side effects so my doctor has me on 325 aspirin…..you do not mention this as a reason to take aspirin…..can you explain??

  • Barb

    are nsaids also blood thinners?

    • The_Beating_Edge_Team

      Aspirin is a Nonsteroidal Anti-inflammatory Drugs (NSAID), and decreases blood clotting by preventing platelets from sticking together. betsyRN

      • Barb

        is naproxen as effective as aspirin in preventing platelets from sticking together?

  • Bonnie

    I had mitral valve repair operation at Cleveland Clinic. Should I be taking aspirin?

    • The_Beating_Edge_Team

      Bonnie – we would need to look at your doctor’s discharge notes. You can contact our heart nurses – see http://www.clevelandclinic.org/heartnurse or your surgeon’s office. betsyRN

  • Kris Beechler

    I had a case of A Fib 14 yrs. Ago. Spent two nights in hospital. It corrected itself with meds within 12 hrs. Was on heart med for one year and heart doc took me off except for low dose of lisinopril. I’m boarder line high BP. I also take a low dose aspirin one a day. Heart history for me, father passed at age 54 from massive heart attack, mother had bad mitral valve and congestive heart failure passed at age 72. I have two older brothers who have had heart attacks. I am 62 and had one PCP tell me to stop aspirin, but another PCP tell me to stay on it because of family history. What is your opinion? Thank you. Kristine B.

  • Joyce

    If I have not had a heart problem but take meds for high blood pressure, and high cholesterol and my Mother & her mother had heart attacks., both died from them at 72 &75. I am 75 and take 81 mg aspirin daily. Should I keep taking it? I work out at health & wellness center sponsored by local hospital twice a week for 1 hour. They take BP before & after exercise.

  • Barbara Bonforte

    What about orthopedic surgeries such as hip replacements? My orthopedics tells me to continue with as a therapy. I have a history of us. Barbara