When I think about medications I often ask myself what the value of that drug is. A drug has a high value if it is effective, inexpensive, has few if any side effects, and is safe. Certain drugs may be effective but are contraindicated because of the risks or the side effects. Aspirin is a drug that has a high value with relatively low risk.
Aspirin has been in use for over 100 years. It can be purchased over the counter and is inexpensive. Aspirin has been used for years as a pain killer, fever reducer, an anti-inflammatory for treating conditions like arthritis. However, it does have side effects and is toxic at very high doses. Today most people use newer drugs to treat these symptoms that have less potential side effects.
Recently aspirin has gained widespread use because of its ability to help prevent problems. One of the side effects of aspirin is that it can make people bleed easily due to inhibition of the platelets in the blood stream that help to form clots. It is good to have platelets that plug holes when we get cut or have bleeding but it is bad to have a clot form inside a blood vessel in the heart or the brain that could lead to a heart attack or a stroke. So it has been discovered that daily use of a low dose of aspirin can reduce the incidence of heart attack and stroke by inhibiting platelets. Actually, aspirin is the first drug given for someone suspected of having a heart attack.
The results of studies on daily aspirin use have shown that people who have already had a stroke or heart attack can significantly reduce the chance of having another event. This is known as secondary prevention. There is also evidence that people who have not had a stroke or heart attack can benefit. This is known as primary prevention. People with risk factors tend to benefit the most. As you recall, risk factors include smoking, high blood pressure, diabetes and high cholesterol. More recently there has been evidence that daily aspirin can reduce the occurrence of certain cancers including colon cancer.
With these factors in mind, the United States Preventive Services Task Force has made recommendations on the use of aspirin. This organization recommends that all men age 45-79 and all women age 55-79 consider taking an aspirin daily. A dose of 81 mg daily is considered effective. The major risk of taking aspirin is bleeding from the gastrointestinal tract. So, this risk has to be weighed against the benefit. For most people in these age groups the benefit outweighs the risk. People who are older or younger can benefit from aspirin if they have risk factors for heart attack and stroke.
Since aspirin does tend to increase bleeding risk, people taking it should consider stopping it before a surgery. If a person develops black or bloody stools, then aspirin should be stopped and that person should be evaluated. Also, recurrent bloody noses would warrant stopping aspirin. Aspirin generally should not be taken with other blood thinners.
Daily use of low dose aspirin has been shown to reduce incidence of stroke and heart attack and possibly reduce cancer risk. For most people this is a safe and effective strategy to reduce health risk. Stay healthy my friends.
By: P. Michael Shattuck, M.D. – Community Health Network Family Physician
