Poonam Chhibber Md Explains The Recent Changes
Low-dose aspirin has long been recommended as a safe and inexpensive way to reduce the risk of cardiovascular disease , heart attacks, strokes and blood clots. In October, the U.S. Preventive Services Task Force changed these long-held recommendations, raising many questions for patients. Heres what you need to know.
What has changed
People aged 60 and older who do not have cardiovascular disease are now strongly discouraged from starting daily aspirin therapy to prevent a first heart attack or stroke.
Why did the aspirin recommendations change?
New research found that the risks of daily aspirin begin to outweigh the benefits starting at age 60. Specifically, the risk of aspirin causing potentially life-threatening bleeding in the brain or gastrointestinal tract increases with age. A review of the literature found that the incidence of these bleeding complications outnumbered preventive effects for people over 60 without established CVD.
What has not changed
Aspirin still has clear benefits for many people who already have cardiovascular disease or who are at high risk for it. These include:
- People with acute coronary artery syndrome
- People with acute occlusive stroke
- People with stable ischemic heart disease, carotid artery disease or peripheral artery disease
If youre already taking aspirin, should you stop?
If youre younger than 60, is it OK to start aspirin?
Who Can Benefit From Aspirin Therapy
Aspirin can benefit people with a history of cardiovascular diseases such as angina , atherosclerosis , congenital heart disease, and transient ischemic attack . Aspirin is also prescribed for those who have had heart attacks or ischemic strokes. In addition to that, aspirin is also used to prevent coronary events in high-risk patients such as those with high blood pressure, high cholesterol, diabetes, and other coronary diseases.
What Is The Typical Dosage Of Aspirin
Depending on the indication, the dosage of aspirin varies. For example, the typical aspirin dose for fever reduction is 325 to 650 mg every 4 to 6 hours as needed. For minor aches and pain, the aspirin dose is 325 to 650 mg every 4 hours. The same concept is applied to the max dose of aspirin the maximum dose depends on the indication. However, the absolute maximum dose of aspirin is 4 g every 24 hours.
Low-dose aspirin is between 75 and 100mg, though aspirin 81 mg is the most commonly used dose It is taken once daily to prevent heart attacks or strokes.
Your doctor can guide you on the most appropriate aspirin based on your medical needs.
Different dosage forms of aspirin include powder, rectal suppository, chewable, or delayed-release oral tablet. Enteric-coated aspirin does not dissolve immediately in the stomach therefore, this form of aspirin causes fewer gastrointestinal adverse effects such as nausea and stomach upset.
Warning: Always consult a doctor before giving aspirin to a child or teenager. Aspirin can cause a rare but serious condition called Reyes syndrome which can cause brain swelling, confusion, and liver damage. Reyes syndrome, also known as Reye-Johnson syndrome, can occur in children or teenagers, especially those recovering from a viral infection such as the flu or chickenpox.
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Choice Of Doses Of Aspirin In Australia
In Australia, aspirin is available as 100 mg tablets . The next highest dose available is 300 mg . Hence, doses of 75-150 mg can be obtained by daily ingestion of either a single 100 mg tablet or half a 300 mg tablet. Alternatively, 150 mg taken on alternate days would seem reasonable, but there are no clinical trial data to support such a regimen.
Whats The Bottom Line
The best way to know if you can benefit from aspirin therapy is to ask your health care provider. You should not start aspirin on your own.
Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.
Last Reviewed: Mar 20, 2019
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Should I Take Aspirin During A Heart Attack Or Stroke
The more important thing to do if any heart attack warning signs occur is to call 911 immediately. Don’t do anything before calling 911. In particular, don’t take an aspirin, then wait for it to relieve your pain. Don’t postpone calling 911. Aspirin won’t treat your heart attack by itself.
After you call 911, the 911 operator may recommend that you take an aspirin. He or she can make sure that you don’t have an allergy to aspirin or a condition that makes using it too risky. If the 911 operator doesn’t talk to you about taking an aspirin, the emergency medical technicians or the physician in the Emergency Department will give you an aspirin if it’s right for you.
Taking aspirin isn’t advised during a stroke, because not all strokes are caused by blood clots. Most strokes are caused by clots, but some are caused by ruptured blood vessels. Taking aspirin could potentially make these bleeding strokes more severe.
Aspirin Isnt Right For Everyone
Even in low doses, aspirin can have significant side effects. The most common ones, occurring in up to 10% of people who take aspirin, are an increased tendency to bleed and stomach upset, including heartburn, nausea, vomiting, or bleeding in the stomach. Other less common side effects include kidney, liver, and nervous system problems.
Although low-dose aspirin is an OTC drug and safe for most people, the FDA recommends that certain individuals not take aspirin in any dose. Those with an allergy to aspirin or salicylates those with a bleeding disorder such as hemophilia or vitamin K deficiency and people with uncontrolled high blood pressure, severe liver or kidney disease, or asthma should avoid using aspirin. In addition, aspirin should not be used by someone who is also taking a prescription blood thinner such as warfarin, Pradaxa, or Xarelto, or another OTC NSAID such as naproxen or ibuprofen .
Before taking any OTC drug on a regular basis, even low-dose aspirin, be sure to talk with your healthcare provider first to find out if its right for you. Always ask your pharmacist to check your prescription and other OTC medications for aspirin interactions or incompatibilities. Even supplements such as fish oil and vitamin D can interact with aspirin.
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Benefits Of Preventive Medication
The USPSTF considered 13 randomized clinical trials involving 161,680 participants that reported on the benefits of aspirin use for the primary prevention of cardiovascular morbidity and mortality.14,25 Most trials used low-dose aspirin of 100 mg/d or less or aspirin every other day and included a balanced number of male and female participants and a broad distribution of ages, with mean age ranging from 53 years in the Physicians’ Health Study28 to 74 years in the Aspirin in Reducing Events in the Elderly trial.24
The evidence showed that aspirin use for primary prevention of CVD was associated with a decreased risk of myocardial infarction and stroke but not cardiovascular mortality or all-cause mortality. Results were similar when including studies using all doses of aspirin compared with studies using low-dose aspirin.14 Since low-dose aspirin is most relevant to current practice, the analyses below report outcomes pooling studies of low-dose aspirin use. Pooled effect estimates of studies using low-dose aspirin were also used to inform the parameters and assumptions of the microsimulation modeling study.26,27
Uspstf Assessment Of Magnitude Of Net Benefit
The US Preventive Services Task Force concludes with moderate certainty that aspirin use for the primary prevention of CVD events in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk has a small net benefit.
The USPSTF concludes with moderate certainty that initiating aspirin use for the primary prevention of CVD events in adults 60 years or older has no net benefit.
See the Table for more information on the USPSTF recommendation rationale and assessment. For more details on the methods the USPSTF uses to determine the net benefit, see the USPSTF Procedure Manual.3
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Aspirin Use To Prevent Cardiovascular Disease: Preventive Medication
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
|Adults aged 40 to 59 years with a 10% or greater 10-year cardiovascular disease risk
|The decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one. Evidence indicates that the net benefit of aspirin use in this group is small. Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit.
|Adults 60 years or older
|The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older.
The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation.
- View the Clinician Summary in PDF
Comparing Two Doses Of Aspirin In The Secondary Prevention Of Cardiovascular Disease
- In ADAPTABLE, compared to 325 mg of daily aspirin, an 81 mg dose of aspirin in patients with established cardiovascular disease was associated with no difference in rates of cardiovascular events or major bleeding.
- The rates of dose switching and dose discontinuation in the group assigned to 325 mg of daily aspirin were high, which may have biased the study towards showing no cardiovascular benefit or elevated bleeding risk for the higher dose of aspirin.
- The methodology of ADAPTABLE was novel as the trial incorporated simplified and economical methods to streamline patient identification and recruitment, follow-up, and outcome ascertainment, which will allow it to serve as a template for future pragmatic comparative effectiveness trials.
A modified per-protocol analysis was performed and demonstrated slightly higher cardiovascular event rates with the 81 mg dose, suggesting a potential small cardiovascular benefit with the 325 mg dose of aspirin. The unfortunate limitations of this trial do significantly reduce the clinical utility of ADAPTABLE and clinicians should be cautious in making recommendations for treatment changes based on the trial results.
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Should I Take Aspirin Therapy If Im Having A Heart Attack
If you experience chest pain or think youre having a heart attack, before you do anything else. Take aspirin only if instructed to by emergency medical technicians. You should take no more than four baby aspirin if you are experiencing a heart attack.
A note from Cleveland Clinic
If youre at risk for heart attack or stroke, daily low-dose aspirin therapy may reduce your risk, especially if youve previously had these conditions. Talk to your healthcare provider about whether aspirin therapy for heart disease is right for you.
Last reviewed by a Cleveland Clinic medical professional on 07/15/2022.
Prevents Clots From Forming Growing
Most heart attacks and strokes happen when a blood clot forms and blocks blood flow in an artery. Under normal circumstances, the body develops a blood clot to stop the loss of blood after an injury. When a blood vessel is damaged, sticky cells called platelets begin to clump together, while proteins in the blood form strands of fibrin. The fibrin creates a net-like structure that holds the forming clot together. Blood clots can form in damaged vessels of the heart or the brain, and these can block blood to the tissue and cause a heart attack or stroke. Aspirin stops clots from forming by preventing the platelets from clumping together.
If you have had a heart attack or stroke, your doctor may prescribe low-dose aspirin to prevent a second event. Low-dose aspirin has been shown to reduce the risk of a first heart attack but has not been definitively proven to reduce the risk of a stroke. Speak with your physician before starting low-dose aspirin for prevention.
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Estimate Of Magnitude Of Net Benefit
The USPSTF commissioned a microsimulation model to estimate the magnitude of net benefit of low-dose aspirin use.26,27 The model incorporated findings from the systematic review to inform its parameters and assumptions, including that daily low-dose aspirin use reduces the risk of nonfatal myocardial infarction and nonfatal stroke, increases the risk of major gastrointestinal bleeding and intracranial hemorrhage, and has no effect on the risk of CVD mortality. As there was insufficient evidence that aspirin use reduces CRC incidence, the modeling study base case assumed no effect of aspirin on CRC incidence.
Modeling outcomes were stratified by age, decade of aspirin initiation , sex, and baseline 10-year CVD risk level . When combined with primary trial data and pooled analyses from the systematic evidence review, the model provided additional information to assess the balance of benefits and harms of aspirin use. The primary model outcomes were net quality-adjusted life-years and life-years gained or lost over a lifetime as a result of aspirin use. Also considered was the effect of stopping aspirin that had been initiated for primary prevention over 5-year age intervals from ages 65 to 85 years.26,27
What Are The Risks Of Aspirin Therapy
Aspirin is an effective pain reliever and fever reducer. In addition to that, aspirins anti-clotting effects, patients taking aspirin have a lower risk of heart attack or stroke. But like all medications, aspirin carries some risks, including:
- Aspirin increases bleeding risk in the GI tract and stomach ulcers
- Aspirin increases bleeding risk in the brain during a hemorrhagic stroke
- Aspirin can cause Reyes syndrome in teenagers and children
Besides these serious side effects, aspirin can cause nausea, vomiting, stomachache, heartburn, and ringing in the ears.
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What Is Aspirin Used For
Prescription aspirin is used to relieve osteoarthritis, rheumatoid arthritis, lupus, and pain and swelling associated with other rheumatologic conditions.
Daily low-dose aspirin is used in combination with other medications to prevent heart attacks and strokes. It can also help prevent transient ischemic attacks and ischemic strokes . However, aspirin does not prevent hemorrhagic strokes .
How To Use Bayer Aspirin 325 Mg Tablet
If you are taking this medication for self-treatment, follow all directions on the product package. If you have any questions, ask your doctor or pharmacist. If your doctor has directed you to take this medication, take it exactly as prescribed.
Take this medication by mouth. Drink a full glass of water with it unless your doctor tells you otherwise. Do not lie down for at least 10 minutes after you have taken this drug. If stomach upset occurs while you are taking this medication, you may take it with food or milk.
Do not crush or chew extended-release tablets or capsules. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.
The dosage and length of treatment are based on your medical condition and response to treatment. Read the product label to find recommendations on how many tablets you can take in a 24-hour period and how long you may self-treat before seeking medical advice. Do not take more medication or take it for longer than recommended unless directed by your doctor. Use the smallest effective dose. Consult your doctor or pharmacist if you have any questions.
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Who Should Not Take Aspirin
The following individuals should not take aspirin without talking to a healthcare professional:
- Children under 18 years of age
- Pregnant women or women who are breastfeeding
- Heavy alcohol drinkers
- People who have a bleeding disorder
- People with upcoming surgical or dental procedures
- People taking other NSAIDs
What Are Warnings And Precautions For Aspirin
This medication contains aspirin. Do not take Zorprin, Bayer Buffered Aspirin, Durlaza, Asatab, Adprin-B, Alka-Seltzer Extra Strength with Aspirin, Alka-Seltzer with Aspirin, Arthritis Pain Formula, Ascriptin, Ascriptin Maximum Strength, ASA, Bayer Children’s Aspirin, Bayer Women’s Low Dose, Bayer Low Adult Strength, Bayer Advanced Aspirin, Bayer Extra Strength, Bayer Extra Strength Plus, Bufferin, Bufferin Extra Strength, Ecotrin, Ecotrin Maximum Strength, Empirin, Extended Release Bayer 8-Hour Caplets, Extra Strength Bayer Plus Caplets, Genuine Bayer Aspirin, Halfprin, Maximum Bayer Aspirin, St. Joseph Adult Chewable Aspirin, St. Joseph Regular Strength, or acetylsalicylic acid if you are allergic to aspirin or any ingredients contained in this drug.
Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.
Allergy to tartrazine dye
- Bleeding GI ulcers, hemolytic anemia from pyruvate kinase and glucose-6-phosphate dehydrogenase deficiency, hemophilia, hemorrhagicdiathesis, hemorrhoids, lactating mother, nasal polyps associated with asthma, sarcoidosis, thrombocytopenia, ulcerative colitis
Effects of Drug Abuse
See “What Are Side Effects Associated with Using Aspirin?”
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