• Preventive Cardiology: Aspirin

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    Commonly Used Brand Name and Generic Aspirins

    Generic name: Acetylsalicylic acid
    General category: Blood thinner, nonsteroidal anti-inflammatory drug (NSAID), salicylate

    Current Uses

    Aspirin is used to treat and prevent a range of conditions. This medication may be taken for:
    • Pain relief
    • Fever reduction
    • Reducing the risk of dying when having a heart attack
    • Preventing a heart attack or stroke
    There is promising evidence to support that taking an aspirin every day is associated with a reduced risk of dying from cancer after it has been diagnosed.

    Recommendations

    The US Preventive Services Task Force (USPSTF) has the following recommendations for a daily low dose of aspirin for the prevention of cardiovascular disease and colorectal cancer:
    • Aged 50-59 years old—Take if there is a 10% or greater risk of either disease within 10 years and daily aspirin can be takenfor at least 10 years without risk of bleeding.
    • Aged 60-69 years old—The recommendation is the same, but in this age range the decision to take daily low-dose aspirin is an individual one. You and your doctor will talk about the benefits and risks before you make a choice.
    • Under 50 and over 70 years old—No recommendation for or against taking daily low-dose aspirin.
    The American Heart Association recommends aspirin for certain people who are at high risk of heart attacks and for people who have experienced a heart attack, stroke, or transient ischemic attack (mini-stroke) if not contraindicated.
    Take only the amount of aspirin instructed by your doctor. If you are taking aspirin regularly and you need a medication to relieve pain, a fever, or arthritis, your doctor may not want you to take extra aspirin. It is a good idea to discuss this with your doctor, so that you will know ahead of time what medication to take.
    Do not stop taking this medication for any reason without first checking with the doctor who directed you to take it.

    Mechanism for How It Works

    • Analgesic/NSAID—This inhibits the body’s production of a hormone-like substance called prostaglandin. This chemical causes pain by stimulating muscles contractions and blood vessel dilation. Aspirin may also fight inflammation, including in plaque caused by atherosclerosis, which causes coronary artery disease.
    • Antithrombotic (blood thinning)/Platelet aggregation inhibitor—This prevents platelets from releasing the prostaglandin thromboxane, which causes platelets to clump together in a blood clot. This helps prevent potentially fatal formation of new blood clots in diseased blood vessels.

    Side Effects

    Drug Interactions

    Aspirin can interact with many types of medications. Some examples include:
    • Other blood thinners
    • Oral medications used to treat diabetes
    • Anticonvulsants
    • Beta-blockers
    • Corticosteroids
    • Other NSAIDs
    • Diuretics
    Be sure to talk to your doctor about the specific medications that you are taking.

    Nutrient/Supplement Interactions

    There are many types of herbs and supplements that can interact with aspirin. Examples include:
    To avoid any interactions, it is important that you talk to your doctor about any herbs are supplements that you are taking before you begin aspirin therapy.

    Other Potential Concerns

    If you have one of the following conditions, it may not be appropriate for you to take aspirin due to the increased risk of complications:
    • Liver or kidney disease
    • Peptic ulcer or other gastrointestinal bleeding disorder, or those at risk for these disorders
    • Allergy or intolerance to aspirin or other nonsteroidal anti-inflammatory drugs
    • Hemophilia or other bleeding problems—the chance of bleeding may be increased
    • Gout—salicylates can make this condition worse and can also lessen the effects of some medications used to treat gout
    • Syndrome of asthma, rhinitis, and nasal polyps
    • Children and adolescents with a viral infection
    • Pregnant or lactating women
    Taking aspirin with selective serotonin reuptake inhibitors may increase the risk of bleeding
    Low-dose aspirin increases risk for gastrointestinal bleeding and hemorrhagic stroke. Do not use without medical advice if you are at increased risk for these diseases.

    What to Watch For

    Examples of common side effects include:
    • Stomach irritation
    • Nausea/vomiting
    • Increased bleeding
    Serious side effects to watch for include:
    • Signs of bleeding in the gut such as vomiting blood or blood in the stool
    • Allergic reaction to aspirin

    RESOURCES

    American Heart Association http://www.heart.org

    US Food and Drug Administration http://www.fda.gov

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    Heart & Stroke Foundation http://www.heartandstroke.com

    References

    Aspirin use to prevent cardiovascular disease and colorectal cancer: Preventive medication. US Preventive Services Task Force website. Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/aspirin-to-prevent-cardiovascular-disease-and-cancer?ds=1&s=aspirin. Updated April 2016. Accessed October 24, 2016.

    Antiplatelet agents for secondary prevention of stroke. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T163233/Antiplatelet-agents-for-secondary-prevention-of-stroke. Updated August 29, 2016. Accessed October 24, 2016.

    Aspirin. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T233300/Aspirin. Updated September 27, 2016. Accessed October 24, 2016.

    Aspirin and heart disease. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/PreventionTreatmentofHeartAttack/Aspirin-and-Heart-Disease%5FUCM%5F321714%5FArticle.jsp#.WA3zGE0VDIU. September 19, 2016. Accessed October 24, 2016.

    Aspirin for primary prevention of cardiovascular disease. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114918/Aspirin-for-primary-prevention-of-cardiovascular-disease. Updated August 13, 2016. Accessed October 24, 2016.

    Holmes MD, Chen WY. Hiding in plan view: The potential for commonly used drugs to reduce breast cancer mortality. Breast Cancer Res. 2012;14(2):216.

    McCowan C, Munro AJ, Donnan PT, Steele RJ. Use of aspirin post-diagnosis in a cohort of patients with colorectal cancer and its association with all-cause and colorectal cancer specific mortality. Eur J Cancer. 2012;49(5):1049-1057.

    Labos C, Dasgupta K, Nedjar H, et al. Risk of bleeding associated with combined use of selective serotonin reuptake inhibitors and antiplatelet therapy following acute myocardial infarction. CMAJ. 2011 Nov 8; 183(16): 1835–1843.Reimers MS, Bastiaannet E, van Herk-Sukel MP, et al. Aspirin use after diagnosis improves survival in older adults with colon cancer: a retrospective cohort study. J Am Geriatr Soc. 2012;60(12):2232-2236.

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