Why you should reconsider taking daily aspirin

last week’s column, I wrote about key cancer screening guidelines all adults need to be mindful of. This week, I’m going over a critical update you may have missed earlier this year for a medication many Americans take on a daily basis: aspirin. 

Low-dose aspirin has been a popular prevention measure for years. Millions of Americans take a daily aspirin, including 29 million who do not carry a diagnosis of cardiovascular disease. A whopping 6.6 million do so without physician supervision. 

Earlier this year, the United States Preventing Services Task Force (USPSTF) made headlines about their latest recommendation on daily aspirin use.  The USPSTF came out strongly against initiating daily aspirin use in adults 60 years and older who have not had a first heart attack or stroke, citing specifically that the risks of internal bleeding outweighed the benefit. Scientists also found little benefit for daily aspirin for most healthy people.

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Low-dose aspirin disrupts common mechanism of heart attacks and strokes

Aspirin is one of the most common and effective medications we have in our arsenal. It’s formally known as acetylsalicyic acid. Although it’s also classified as a non-steroidal anti-inflammatory drug (NSAID), it’s often confused for ibuprofen. But the two common medications are very different. Traditionally, aspirin has been used to treat fever, reduce pain or tamper down inflammation.

The recent guideline updates however specifically refer to its common long-term use in preventing heart attacks, ischemic strokes or blood clots in those patients deemed to be high-risk.

Aspirin’s ability to suppress the normal function of platelets is why it’s used for this preventive purpose. When our blood vessels are damaged, the body sends out platelets to stop bleeding. When they arrive, platelets aggregate or clump together. 

However, abnormal platelet aggregation in those with cardiovascular disease can result in heart attacks or strokes. Low-dose (“baby”) aspirin irreversibly blocks the production by platelets of a substance called thromboxane A2. Thromboxane A2 both stimulates activation of new platelets and increases platelet aggregation, or clumping. As such, low-dose aspirin is a potential inexpensive yet powerful tool against abnormal platelet clumping that could lead to heart attack or stroke in those high-risk for cardiovascular disease.

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Guidelines reflects concern for aspirin’s increased risk of bleeding

To be clear, the new USPSTF guideline is not challenging the proven benefit of aspirin in preventing heart attacks or strokes. Scientists reaffirm that the benefit of aspirin likely outweighs the risk of side effects specifically for those who have already had a first heart attack or stroke. 

However, scientists are concerned about the risk of side effects in the aforementioned millions of Americans taking a daily aspirin without physician supervision and without an actual diagnosis of cardiovascular disease.

In the emergency room, we do not recommend aspirin and other NSAIDs like ibuprofen and naproxen for patients with peptic ulcer disease, gastritis, hemophilia, kidney disease and other conditions because aspirin is known to increase the risk of gastrointestinal bleeding. While beneficial in reducing the future risk of a recurrent heart attack or stroke, aspirin’s ability to tamp down on platelet aggregation also leads to a thinning of the blood. Aspirin also unfortunately inhibits stomach-protective substances like prostaglandins which make people more susceptible to ulcers, gastritis and other complications. 

Here’s what research says.

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