Aspirin Therapy in Heart Disease
For more than 100 years, aspirin has been used as a pain reliever. Since the 1970s, aspirin has also been used to prevent and manage heart disease. The American Heart Association recommends baby aspirin for "those at risk of heart attack (if told by their doctor) and for those who have survived a heart attack". The Food and Drug Administration (FDA), however, believes that aspirin should only be taken by patients who have heart disease or a history of heart attack or stroke. The FDA states that taking aspirin creates a risk of bleeding that outweighs the benefits of taking aspirin for people who do not have a history of heart attack or stroke.
Talk to your doctor first before taking aspirin. The following facts are meant to help you talk to your doctor about whether aspirin therapy is right for you.
How does aspirin benefit the heart?
- Prevents blood clots. Aspirin blocks factors in the blood that cause blood clots to form. Blood clots are good when they stop bleeding; but harmful when they clog the arteries leading to the heart or brain and increase the risk of heart attack and stroke.
- Aspirin reduces the risk of future heart attack and ischemic stroke in people with a prior history of these conditions.
- Reduces the risk of death. When taken during a heart attack, aspirin greatly reduces heart damage and increases the chance of survival.
Low dose aspirin may also decrease risk of certain types of cancer.
What are the risks of aspirin therapy?
Aspirin has been linked to increased survival in certain patient populations, but it is a medication that has risks as well. Always ask your doctor before starting any medication, including aspirin.
- Aspirin increases the risk of bleeding and ulcers in the stomach (gastrointestinal).
- During stroke, aspirin can increase the risk of bleeding into the brain.
Who can benefit from aspirin therapy?
Aspirin is recommended for people who have been diagnosed with heart and vascular disease. This includes:
- People with atherosclerosis
- People who have had an ischemic stroke or transient ischemic attack (TIA)
- People who have had a heart attack or those who are experiencing symptoms of heart attack
- People who have angina (chest pain)
- People who have had bypass surgery, angioplasty or stent(s) to treat heart disease
How much aspirin should I take?
Always talk to your doctor about the benefits and risks of aspirin therapy before beginning a regular regimen.
A dose of 81 mg, or a baby aspirin is recommended as the daily dose to prevent future heart events. There are also lower and higher dose adult aspirin varieties available. Check with your doctor first to find out what dose is right for you.
How should I take aspirin?
- Aspirin should not be taken on an empty stomach. Take aspirin with a full glass of water with meals or after meals to prevent stomach upset.
- Do not break, crush, or chew extended-release tablets or capsules--swallow them whole. Chewable aspirin tablets may be chewed, crushed, or dissolved in a liquid.
- Tell your doctor if you are allergic to aspirin, ibuprofen, or naproxen.
- Aspirin should never be taken in place of other medications or treatments recommended by your doctor.
- Do not drink alcoholic beverages while taking aspirin. Taking aspirin with alcohol increases the chance of stomach bleeding.
- While taking aspirin, ask your doctor what other medicines you may take for pain relief or minor colds. Read the labels of all pain relievers and cold products to make sure they are aspirin-free. Other medicines containing aspirin or nonsteroidal anti-inflammatory drugs may cause bleeding problems when taken in combination with your regular aspirin therapy.
- Before any surgical or dental procedure or emergency treatment, tell the doctor or dentist that you are taking aspirin. You might need to stop taking this medicine for five to seven days before dental work or surgery. However, do not stop taking this medicine without first consulting with your doctor.
If you are experiencing symptoms of a heart attack, first call 9-1-1. DO NOT DELAY CALLING 9-1-1. After you call 9-1-1, if you do not have a history of aspirin allergy or bleeding, emergency personnel may advise that you chew one 325 mg aspirin slowly. It's especially effective if taken within 30 minutes of the onset of symptoms. Do NOT take an aspirin for symptoms of stroke.
Are there any side effects?
Some common side effects of aspirin include nausea, upset stomach, nervousness, and trouble sleeping. Call your doctor if any of these symptoms become severe or do not go away.
If you have any of the following side effects, contact your doctor right away:
- Severe stomach pain or heartburn
- Severe nausea or vomiting.
- Any signs of unusual bleeding, such as blood in the urine or stools, nosebleeds, any unusual bruising, heavy bleeding from cuts, black tarry stools, coughing up of blood, unusually heavy menstrual bleeding or unexpected vaginal bleeding, vomit that looks like coffee grounds
- Signs of allergy including hives, facial swelling, rash
- Asthma attack (also indicates an allergy)
- Ringing in the ears
- Severe headache pain
Who should not take aspirin?
- Children under the age of 18 who are recovering from a viral infection such as the flu or chicken pox
- Pregnant women (unless otherwise directed by your doctor)
- People who are about to havea surgery
- Heavy drinkers
- People with ulcers or any bleeding problem
- People taking regular doses of other pain medications, such as Motrin
- People who are allergic to aspirin
The final message: Talk to your doctor to see if you should take aspirin. Do not take aspirin for prevention without talking to your doctor first.
Reviewed by Dr. Ben Barzilai -Section Head of Clinical Cardiology - Robert and Suzanne Tomsich Department of Cardiovascular Medicine in the Miller Family Heart and Vascular Institute.
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