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.

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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).

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:

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  • 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.

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.

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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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