New Advice Differs From Previous Recommendations
The latest guidance pivots from recommendations issued in 2016, which suggested that people ages 50 to 59 with a risk of cardiovascular disease that is 10 percent or greater in the next decade and a low risk for bleeding take a daily low-dose aspirin to reduce the likelihood of suffering a heart attack or stroke. The decision to start taking aspirin for preventive reasons should be an individual one for adults ages 60 to 69 who are at risk for cardiovascular disease, the 2016 recommendations said.
The groups new recommendations align more closely with 2019 guidance from the American Heart Association and the American College of Cardiology.
Even still, aspirin use for the primary prevention of cardiovascular-related incidents is common in the U.S., and is often self-initiated rather than recommended by a physician, the task forces October report says. A 2017 National Health Interview Survey found that 23.4 percent of adults age 40 or older and without cardiovascular disease took aspirin for primary prevention among adults 60-69 years old, 34.7 percent reported aspirin use.
According to the American Heart Association, nearly half of American adults have some type of cardiovascular disease a catchall term for conditions that affect the heart and blood vessels. Cardiovascular disease accounts for more than 1 in 4 deaths in the U.S. High blood pressure is the leading risk factor for the disease diabetes, obesity and age can also increase risk.
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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?
An Aspirin A Day Not So Fast
The U.S. Preventive Services Task Force has recommended that taking a low-dose aspirin daily can… help prevent both heart disease and colorectal cancer in adults ages 50 to 69.
I thought we’d put this one to bed. A large-scale study showed that low-dose aspirin taken once a day can prevent heart attacks and some common types of cancer, including colon cancer.
I wrote about this topic just over a year ago, and I’ve followed my own advice, taking daily 81mg aspirins since then. The US Preventative Services Task Force recommends this too: regular, low-dose aspirin for people between the ages of 50 and 69 helps to prevent heart attacks, strokes and some types of cancer.
But now, a new study just published in The Lancet upends that advice. It’s not that the previous study was wrongit wasn’t. It’s just that the effects of aspirin vary significantly based on body weight. Essentially, the new study finds, almost all of the benefits accrue to people who weigh 70 kilograms or less.
The study, a re-analysis by Peter Rothwell and colleagues of ten large trials that included 117,279 participants, is too long and complex to summarize here, so I’ll just highlight a few key points. 31133-4/fulltext” rel=”nofollow”> just by clicking here.)
The bad news, for the rest of us, is that we seem to get no heart-related benefits from taking a daily low-dose aspirin.
What to do now? The new study concludes that:
“The one-dose-fits-all strategy for daily aspirin use is unlikely to be optimal.”
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Whats The Link Between Aspirin And Heart Attack Prevention
Aspirin is a blood thinner. It may help prevent heart attacks by making it harder for platelets in the blood to clot.
Blood clots are part of a healthy circulatory system. When youre wounded, clotting prevents excess blood loss.
Clots become dangerous when they move around the body or stop the flow of blood to important organs. A heart attack occurs when platelets form a clot that blocks the flow of blood to the heart.
This is more likely to occur among people who have certain health conditions, such as high blood pressure or high cholesterol. These conditions weaken and narrow the arteries, making it harder for blood to circulate freely.
If you have risk factors for blood clots, your doctor might prescribe a blood thinner to reduce your risk for a heart attack.
I Was Told To Take 325 Mgs Of Aspirin Daily After I Had A Stroke Why
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How Does Aspirin Work To Prevent A Heart Attack Or Stroke
Aspirin slows the blood’s clotting action by reducing the clumping of platelets. Platelets are cells that clump together and help to form blood clots. Aspirin keeps platelets from clumping together, thus helping to prevent or reduce blood clots.
During a heart attack, blood clots form in an already-narrowed artery and block the flow of oxygen-rich blood to the heart muscle . When taken during a heart attack, aspirin slows clotting and decreases the size of the forming blood clot. Taken daily, aspirin’s anti-clotting action helps prevent a first or second heart attack.
More Isn’t Always Better
If you and your doctor decide you should be taking aspirin daily, the next question is, “How much?” In the land of the super-size, is it any wonder that we think that if one pill is good, two must be better, and if 100 milligrams may help prevent cancer, 200 or 300 milligrams must have twice or three times as much cancer-busting power? Stop right there. Medications don’t work that way, and especially in the case of aspirin and other NSAIDs, a little goes a long way.
“Low-dose aspirin, a ‘baby aspirin’ dose of 81 milligrams, is safer and just as effective as the standard adult dose of 325 milligrams,” says Dr. Fendrick. “When a drug has serious side effects, as aspirin does, you want to give the lowest effective dose. We know now that you don’t need 325 milligrams in a great majority of circumstances.”
A patient who’s having a heart attack right now, for example, should be given a full 325-milligram dose of aspirin, but the person at elevated risk for a heart attack, who’s taking daily aspirin as a preventive measure, should stick with the smaller 81-milligram dose.
Taking low-dose aspirin isn’t the only way to maximize the drug’s benefits while minimizing its dangers. For people at increased risk of gastrointestinal complications, Fendrick recommends combining any aspirin therapy with a prescribed proton pump inhibitor such as Prevacid, Prilosec, or Nexium.
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When Should You Seek Immediate Medical Care
If you think you or a loved one has experienced an aspirin overdose, seek immediate medical attention.
You can also call Poison Control at 800-222-1222. Theyre open 24 hours a day, seven days a week.
If you arent sure if you took enough to be considered an overdose, its best to go to the emergency room anyway. You could otherwise miss valuable time to begin treating the poisoning.
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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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
Diagnosing An Aspirin Overdose
A doctor will begin by asking you or your loved one about how much aspirin was taken. Taking empty pill bottles may help a doctor understand how much may have been consumed.
The doctor may order blood and urine testing to determine how severe the levels of salicylates are in your blood and how much the aspirin has affected your body. Examples of tests include:
- plasma salicylate levels
- basic metabolic panel
Aspirin can have a delayed absorption in the body. As a result, your doctor may take repeated blood level tests to make sure aspirin levels arent getting higher over time.
If you arent sure how much you took, a doctor will try to rule out other causes. Some of the other conditions that may have similar symptoms to an aspirin overdose include:
- diabetic ketoacidosis
Aspirin poisoning treatments depend on your overall health as well as the level of aspirin in your blood. In severe cases, treatments may include the following:
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Mechanism Of Action Of Aspirin
In platelets, the predominant product of the pathway for synthesis of prostaglandins is thromboxane A2 which is a powerful promoter of platelet aggregation. In a developing thrombus, thromboxane is produced by stimulated platelets and secreted into the surrounding medium. There it acts synergistically with other platelet stimuli to enhance platelet stickiness and, hence, platelet aggregation. Aspirin prevents the production of thromboxane by inhibiting the enzyme cyclooxygenase. This leads to inhibition of the mechanisms of both haemostasis and thrombosis, as shown by a prolongation of the bleeding time and by a decreased tendency to arterial thrombosis in experimental animals. As aspirin binds to platelet cyclooxygenase irreversibly, it inhibits the function of the platelets for the rest of their 8-10 day lifespan.
Aspirin also inhibits cyclooxygenase in the endothelium of the arteries and veins, and hence blocks the production of prostacyclin, a powerful inhibitor of platelet aggregation. This aspirin-induced loss of prostacyclin production potentially reduces the overall antithrombotic action of aspirin, but the clinical significance is not known. The inhibition of prostacyclin formation is reversible, because the endothelium is capable of resynthesising cyclooxygenase.
Immediate First Aid Works To Minimize Blood Clotting Triggered By Plaque Ruptures
How should you take aspirin for a heart attack? You’ve always been healthy, but you seemed to run out of steam at your wife’s 60th birthday dinner last week. And now your chest feels heavy, as if you’re in a vise. You take some antacids, even though it’s 7:00 a.m. and you haven’t even had breakfast. But you get no relief, and the pain is spreading to your jaw and shoulder. You call your wife, who takes one look at you and rushes to the phone. After calling 911, she brings you an aspirin and some water.
Your wife got it right: You may be having a heart attack, and you need to get to the hospital fast. You also need to get some aspirin into your system quickly but should you chew the tablet or swallow it?
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Aspirin Therapy: How Much Is Too Much
Baby Aspirin Looks to Be the Best Choice for Prevention
Sept. 22, 2003 — Millions of Americans take an aspirin every day to protect their hearts, but there is still widespread confusion about what’s the best dose. Does baby aspirin protect as well as an adult-strength tablet? And is it riskier to take an adult-strength aspirin every day?
A new international study offers some of the best evidence yet that when the risks and benefits of aspirin therapy are weighed, a daily baby aspirin is your best bet.
Researchers compared three different daily aspirin therapy doses and found a similar frequency of heart attacks and strokes among patients taking each of them. But those taking the highest doses — equivalent to roughly an adult-strength tablet every day — were at much greater risk for developing bleeding complications. The findings are in the Oct. 7 issue of the American Heart Association journal Circulation.
Should You Take Daily Aspirin
It depends. Basically, it all boils down to whether youre at high risk for having a heart-related problem factors might include high blood pressure, high cholesterol, being a smoker or having diabetes and your previous medical history.
If youve had a heart attack, or a stent, or bypass surgery, or some other manifestation of coronary heart disease, then aspirin is recommended in order to prevent a recurrent event, says Dr. Nissen.
If you havent had a cardiovascular event, but are taking daily aspirin anyway, should you stop taking it? It also depends. In general, I tell my patients to stop, says Dr. Nissen. But different physicians may have a different perspective. They might argue that somebody whos taken it for 10 years and has a very low risk of a gastrointestinal or cerebral bleed, maybe its not a bad idea to keep taking it.
What you definitely shouldnt do is just stop or start taking aspirin without consulting your doctor first. Its always good idea to talk to your doctor, says Dr. Nissen. Nothing in medicine is ever black and white, and individualizing care is always a good idea. Talk to your doctor and try to work it out together. We call that shared decision-making. Its always the right thing to do.
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Is Daily Aspirin Right For You
Doctors typically prescribe daily aspirin therapy for people who have certain cardiovascular risk factors.
You might benefit from taking aspirin every day if you answer yes to one or more of the following questions:
- Have you previously had a heart attack?
- Have you previously had a clot-related stroke?
- Have you had a stent inserted in a coronary artery?
- Do you have chest pain caused by angina?
- Have you had coronary bypass surgery?
- Are you a man over 50 or a woman over 60 with diabetes and at least one other heart disease risk factor?
- Do you have a family history of heart attacks?
If you think youre at risk, make an appointment to discuss daily aspirin with a doctor.
Daily Aspirin Isn’t For Everyone
Certain people may not be good candidates for taking aspirin every day. People who are regular alcohol drinkers and people at risk for stomach bleeding are not good candidates for daily aspirin. It may also include people who have liver or kidney disease. Also, some people are sensitive or allergic to aspirin.
Your doctor or dentist may tell you not to take aspirin for a certain time before a medical or dental procedure. If you’re already on a low-dose daily aspirin, you’ll need to stop taking it temporarily to reduce your risk of bleeding.
Aspirin can have negative consequences if you take it with some other drugs. Taking daily aspirin and also taking certain blood thinners can thin the blood too much. This can be dangerous. Also, NSAIDs can interact with some medicines, such as blood pressure drugs.
Because of the risks, its important to never start an aspirin regimen on your owneven a low-dose regimen. Always talk with your doctor first and follow his or her advice.
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Is Aspirin Safe For Children
Doctors do not usually recommend aspirin for people under 18. This is because it can increase the risk of a serious condition called Reyeâs syndrome, which can appear after a viral infection such as a cold, the flu, or chickenpox. Reyeâs syndrome can lead to permanent brain injury or death.
However, a clinician may prescribe aspirin to a child under supervision if they have Kawasaki disease or to prevent blood clots from forming after heart surgery.
For children, doctors usually recommend acetaminophen or ibuprofen , in appropriate doses, instead of aspirin.
People with the following conditions should be cautious about taking aspirin, and should only do so if a doctor recommends it:
- bleeding disorders, such as hemophilia
- uncontrolled high blood pressure
- peptic or stomach ulcers
- liver or kidney disease
Under a doctorâs supervision, people who are pregnant or breastfeeding may take low-dose aspirin. Doctors usually do not recommend high-dose aspirin during pregnancy.
Anyone with a known allergy to aspirin or any other NSAID, such as ibuprofen, should avoid these drugs.
Doctors do not administer aspirin during a stroke because not all strokes are caused by blood clots. In some cases, aspirin could make a stroke worse.
Also, anyone who drinks alcohol regularly or is undergoing dental or surgical treatment, however small, should ask a doctor before taking aspirin.
An interaction may involve one medication making another less effective or the combination being dangerous.