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Why take aspirin?

Aspirin, the common pain reliever that has been in our medicine cabinets for more than a century, also has a talent for prevention.

Aspirin prevents blood clots from forming in your arteries. This can prevent a heart attack or stroke.

Who should take aspirin?

For people who have had a heart attack: Aspirin can help prevent a second heart attack. Your doctor has probably already prescribed aspirin for you.

For people who have had a stroke: Aspirin can help prevent a second stroke or a transient ischemic attack (TIA), which is often a warning sign of an impending stroke.

For people who have never had a heart attack or stroke: Talk to your doctor before you start taking aspirin every day. Aspirin may reduce your chance of having a heart attack or a stroke if you have coronary artery disease or certain risk factors, such as diabetes, high blood pressure, high cholesterol, or smoking. If you have a higher risk for a heart attack or stroke, aspirin will have even more benefit for you.

Aspirin may also be used by people who:

  • Had bypass surgery or angioplasty.
  • Had a stroke or transient ischemic attack (TIA).
  • Have peripheral arterial disease.
  • Have atrial fibrillation.

For help on the decision to take aspirin, see:

Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke?

Doctors use different guidelines to decide who should take daily aspirin. But no matter which guideline your doctor follows, he or she will look at your health and at your risk for a heart attack or stroke. Then you and your doctor will balance the benefits and the risks of taking a daily aspirin to see if a daily aspirin is right for you.

If you have a relatively low risk for a heart attack or stroke, the benefits of preventive aspirin therapy may be outweighed by the increased risk of bleeding problems.

Your doctor can help you know your risk of having a heart attack or stroke and the risk of bleeding from aspirin.

Who should not take aspirin?

People who have certain health problems shouldn't take aspirin. These include people who:

  • Have a stomach ulcer.
  • Have recently had a stroke caused by bleeding in the brain.
  • Are allergic to aspirin.
  • Have high blood pressure that isn't under control.
  • Have asthma that is made worse by aspirin.

If you think you are having a stroke, do not take aspirin because not all strokes are caused by clots. Aspirin could make some strokes worse.

Gout can become worse or hard to treat for some people who take aspirin.

If you can't take aspirin, your doctor may have you take clopidogrel (Plavix) to help prevent a heart attack or a stroke.

If you take an anticoagulant, such as warfarin (Coumadin), talk with your doctor before taking aspirin, because taking both medicines can cause bleeding problems.

What precautions do I need to take?

Limit alcohol

Drinking 3 or more alcoholic drinks every day while taking daily aspirin increases your risk for liver damage and stomach bleeding. If your doctor recommends aspirin, limit or stop alcohol usage.

Talk to doctor before a surgery or procedure

Before you have a surgery or procedure that may cause bleeding, tell your doctor or dentist that you take aspirin. Aspirin may cause you to bleed more than usual. He or she will tell you if you should stop taking aspirin before your surgery or procedure. Make sure that you understand exactly what your doctor wants you to do.

Do not suddenly stop taking aspirin without talking to your doctor first. Talking to your cardiologist first is especially important if you have had a stent placed in a coronary artery.

Tell your doctor if you notice that you bruise easily or have other signs of bleeding. These include bloody or black stools or prolonged bleeding from cuts or scrapes.

Tell your doctor about all your medicines

Aspirin should not be taken with many prescription and over-the-counter drugs, vitamins, herbal remedies, and supplements. So before you start aspirin therapy, talk to your doctor about all the drugs and other remedies you take.

Be careful taking pain relievers

Although nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, relieve pain and inflammation much like aspirin does, they do not affect blood clotting in the same way that aspirin does. Do not substitute NSAIDs for aspirin. NSAIDs may increase your risk for a heart attack or stroke.

Take NSAIDs safely. If you need both aspirin and an NSAID pain reliever every day, talk to your doctor first. Ask your doctor what pain reliever you should take. You may be able to use another type of pain reliever, such as acetaminophen, to treat your pain.

If you take an NSAID every day, your doctor may recommend that you take the NSAID and aspirin pills at different times. If you take these pills at the same time, aspirin might not work as well to prevent a heart attack or stroke. Do not take the NSAID pill during either the 8 hours before or the 30 minutes after you take aspirin. Here's an example: Take your aspirin. Wait 30 minutes. Then take your NSAID.

If you take an NSAID once in a while, it does not seem to cause problems with aspirin.

More information

For more safety tips, see:

Blood Thinners Other Than Warfarin: Taking Them Safely

How do you take aspirin?

Your doctor will recommend a dose of aspirin and how often to take it. Most people take aspirin every day to help prevent a heart attack or a stroke, but others might take aspirin every other day. Be sure you know what dose of aspirin to take and how often to take it.

Low-dose aspirin (81 mg) is the most common dose used to prevent a heart attack or a stroke. But the dose for daily aspirin can range from 81 mg to 325 mg. One low-dose aspirin contains 81 mg. One adult-strength aspirin contains about 325 mg.

For aspirin therapy, do not take medicines that combine aspirin with other ingredients such as caffeine and sodium.

Low-dose aspirin seems to be as effective in preventing heart attacks and strokes as higher doses.

Take aspirin with food if it bothers your stomach.

How does aspirin work to prevent a heart attack or stroke?

Aspirin protects you from having a clot-related stroke in the same way it protects you from having a heart attack.

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 (or to part of the brain, in the case of stroke). 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.

Health Tools help you make wise health decisions or take action to improve your health.

Decision Points focus on key medical care decisions that are important to many health problems.
  • Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke?
Actionsets are designed to help people take an active role in managing a health condition.
  • Blood Thinners Other Than Warfarin: Taking Them Safely

Organizations

American Heart Association (AHA) www.heart.org National Heart, Lung, and Blood Institute (NHLBI) (U.S.) www.nhlbi.nih.gov
  • Atrial Fibrillation
  • Coronary Artery Disease
  • Heart Attack and Unstable Angina
  • Stroke
  • Transient Ischemic Attack (TIA)

Other Works Consulted

  • Antiplatelet therapy for patients with stents. (2008). Medical Letter on Drugs and Therapeutics, 50(1292): 61–63.

  • Antithrombotic drugs (2011). Treatment Guidelines From The Medical Letter, 9(110): 61–66.

  • Eikelboom JW, et al. (2012). Antiplatelet drugs: Antithrombotic therapy and prevention of thrombosis, 9th ed.–American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): e89S–e119S.

  • Goldstein LB, et al. (2010). Guidelines for the primary prevention of stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. Published online December 2, 2010 (doi: 10.1161/STR.0b013e3181fcb238). Also available online: http://stroke.ahajournals.org/content/42/2/517.full.

  • Paikin JS, Eikelboom JW (2012). Aspirin. Circulation, 125(10): e439–e442.

  • Pignone M, et al. (2010). Aspirin for primary prevention of cardiovascular events in people with diabetes: A position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Circulation, 121(24): 2694–2701.

  • Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.

  • Steinhubl SR, et al. (2009). Aspirin to prevent cardiovascular disease: The association of aspirin dose and clopidogrel with thrombosis and bleeding. Annals of Internal Medicine, 150(6): 379–386.

  • U.S. Food and Drug Administration (2006). Concomitant use of ibuprofen and aspirin: Potential for attenuation of the anti-platelet effect of aspirin. Food and Drug Administration Science Paper. September 8, 2006. Available online: http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM161282.pdf.

  • U.S. Preventive Services Task Force (2009). Aspirin for the prevention of cardiovascular disease. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.htm.

  • Vandvik PO, et al. (2012). Primary and secondary prevention of cardiovascular disease: Antithrombotic therapy and prevention of thrombosis, 9th ed.– American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): e637S–e668S.



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