Rarely does a week go by that I don’t give at least one patient 300mg of aspirin.
For people with acute chest pain, possibly having a heart attack, it can literally be life-saving.
It helps make the blood less sticky and dissolve clots in the arteries, allowing oxygen to reach the heart muscles.
Aspirin is available in low and high doses and is available at most pharmacies.
There is a large dose of 300mg, for the treatment of a suspected heart attack or as an anti-inflammatory and pain reliever; and a daily dose of 75-100 mg that people take to prevent heart attacks and strokes.
But as with any drug, there are risks.
For people with acute chest pain, possibly having a heart attack, aspirin can be life-saving. It helps make the blood less sticky and dissolve clots in the arteries, allowing oxygen to reach the heart muscles (file photo)
The unique problem with aspirin is that it is cheap and widely available, so it is easy to self-prescribe.
In fact, millions of apparently healthy people in this country are believed to take it daily to prevent heart attack or stroke.
For centuries it has been used in the form of salicylic acid – derived from the bark of willow trees – as an anti-inflammatory drug.
Then, in 1899, the Bayer pharmaceutical company purified it and created the drug we know as aspirin.
Originally used to treat arthritis, a family physician in California discovered its role in preventing heart attacks and strokes in the 1950s, and it was soon hailed as a wonder drug.
Doctors began recommending that anyone over the age of 55 who feared they were at risk of a heart attack take the drug daily as a preventative.
Aspirin works by acting on the platelets, which play a key role in forming clots. But herein lies the problem: the way it works is also the way it can do damage.
Over the years, there have been a slew of studies that have reinforced warnings about the drug’s side effects, including internal bleeding and stomach ulcers.
Just a week ago, some news outlets reported on a study showing that it can cause anemia [where your body doesn’t have enough red blood cells, usually a result of bleeding] in elderly patients.
Published in the journal Annals of Internal Medicine, it looked at data from more than 19,000 over-65s in the US and Australia who took low-dose aspirin (100mg) or a dummy tablet daily for five years.
The theory was that aspirin would increase life expectancy and reduce the risks of dementia.
The results showed that taking aspirin made no difference, but it did carry risks.
As we age, our risk of anemia increases for many reasons: less iron is absorbed through our gut, bone marrow is less effective at making red blood cells, and the kidneys produce less of the hormone erythropoietin that helps make red blood cells .
But the study showed that the risk of anemia was 20 percent higher in older people who took aspirin than in those who took the dummy tablet.
When the researchers looked at the causes, they found that people taking aspirin had lower iron levels – almost certainly caused by more bleeding in their stomachs.
It wasn’t just minor bleeding either; the rate of catastrophic stomach bleeding was 50 percent higher in those taking aspirin than those using the pacifier.
So what does this mean for you and me?
A few years ago I treated a man in his 70s. He lived a very healthy life: he didn’t smoke, ate well and played tennis three times a week.
He had watched two of his friends die of heart attacks and had read about the benefits of taking a low dose (75 mg) of aspirin every day – the dose you can buy at any pharmacy.
He came to the ER because he felt dizzy. His blood pressure was low and just as we were trying to figure out what was wrong, he gave us the answer by vomiting bright red blood.
We gave him six units of blood and rushed him to an endoscopy to find out what was wrong.
The bleeding came from an ulcer and was stopped.
The cause was almost certainly the aspirin he was taking, but shouldn’t have been taking. He survived, but he was lucky.
This new study confirms that aspirin can be dangerous if taken over a long period of time, especially if you’re older.
It may also not be appropriate for doctors to recommend it as a preventative treatment, as they often do, if you haven’t had a heart attack or stroke.
In 2022, the U.S. Preventive Services Task Force changed its recommendation for those over 60 and advised against the use of daily aspirin to prevent a first heart attack or stroke because the benefit does not outweigh the potential risk of internal bleeding.
(The advice is different if you’ve had a heart attack or stroke and are trying to prevent another one.)
The NHS also says you should only take low-dose aspirin daily if your doctor recommends it because of a high risk of heart attack or stroke.
We are also cautious when prescribing long-term aspirin, with 2022 NHS guidelines saying it should be used with caution in the elderly and those with anaemia.
What about those who take aspirin because they have a specific heart rhythm problem?
My advice is to be guided by your doctor; there are new drugs that are more effective than aspirin for this.
What about taking it before a flight to reduce the risk of deep vein thrombosis?
The answer is an emphatic no. The risks of causing a bleed at 35,000 feet are too high.
Instead, take regular walks and wear compression stockings.
Aspirin is still a drug that people should have around the house for emergencies because if you get severe chest pain, a 300mg dose can make a huge difference to your chance of survival.
But in general you should not self-medicate – always discuss this with your doctor first.
Twitter: @drobgalloway