By Michael J. Blaha, MD, MPH
May 16, 2014

Michael J. Blaha, MD, MPH
Michael J. Blaha, MD, MPH

In small doses, daily aspirin use can help thin the blood and protect against heart attacks and strokes. Aspirin use, however, comes at a big price: an increased risk of bleeding. How can you decide whether a baby aspirin is right for you?

A better appreciation of the risks of aspirin use

When word got out that aspirin may be beneficial in this way, many doctors appropriately began prescribing the drug to high-risk patients, or to patients who have had prior heart attacks or strokes—and tens of thousands of heart attacks and strokes have probably been averted due to this practice.

The down side of this development, however, is that many more people also started taking an aspirin on their own, without consulting their doctors, and this practice probably resulted in many unnecessary fatalities.

Aspirin can cause nuisance bleeding (like nosebleeds or bleeding gums), but it can also cause more serious episodes of bleeding. Aspirin use, for example, can be associated with gastrointestinal bleeding and, in less common cases, aspirin can cause bleeds in the brain.

In fact, of all the medicines that we use, aspirin is near the top of the list of those causing medication-related hospitalizations.

The FDA changes the aspirin label

In response to the delicate balance between aspirin’s benefits and its harms, the FDA recently issued a consumer update that clarified the agency’s position on aspirin use. The FDA experts denied a proposed change to the drug’s “label” that would have included “prevention of heart attack and stroke in all patients.”

This refusal is really important because the FDA regulates drug approval in the United States and decides which medical conditions a drug can be approved for. In other words, changes in drug labeling affect the ways drugs can be marketed and sold.

As a result of the FDA’s decision, over-the-counter aspirin containers can no longer claim that the drug can be used for so-called “primary prevention”—that is, in patients who have never yet had a heart attack or stroke in the past. The FDA’s primary goal here was to limit the potential harm that can occur when people with less than a complete understanding of the risks of aspirin use the drug on their own to medicate themselves.

Aspirin can be dangerousdiscuss its use with your doctor

Aspirin still plays a critical role in the fight against repeated heart attacks and strokes; however, by using it without understanding your true level of risk, you may possibly do yourself more harm than good.

If you are curious about whether you should be using aspirin, you must first ask your doctor to estimate your risk of cardiovascular disease. The message here is simple: if you are not at high risk, it’s probably better not to take an aspirin. Other risk assessment tools, like a coronary artery calcium score, can also be invaluable in making this important decision. In some circumstances, where the risk-benefit calculations are less certain, doctors may also consider a patient taking a dose of aspirin every other day. This produces a milder effect and may reduce nuisance bleeding.

The key point here is that you must discuss this issue with your doctorespecially those readers who may have already started taking aspirin on your own.

Like many drugs, the life-saving properties of aspirin must be seen and appreciated against the backdrop of the serious risks associated with the unsubstantiated and unsupervised usage of the drug. We must have great respect for both the life-saving properties and the life-threatening properties of this ancient drug.

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