Aspirin Therapy (Guidelines for Heart Attack and Stroke Prevention)

  • Medical Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical Author: Daniel Lee Kulick, MD, FACC, FSCAI
    Daniel Lee Kulick, MD, FACC, FSCAI

    Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.

  • Medical Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

What are the side effects of aspirin?

Serious side effects of aspirin and other NSAIDs occur infrequently. However, they generally tend to be more frequent with higher doses. Therefore, it is advisable to use the lowest effective dose to minimize side effects.

The most common side effects of aspirin involve the gastrointestinal system, which include

  • Ulcers of the stomach and duodenum (first part of the small intestine)
  • Abdominal pain
  • Nausea
  • Gastritis (inflammation of the stomach)
  • Even serious gastrointestinal bleeding from ulcers

Other side effects of aspirin include:

Sometimes, ulcers of the stomach and bleeding occur without any abdominal pain, and the only signs of bleeding may be:

Another serious but rare side effect of aspirin is intracranial hemorrhage (bleeding into the tissues of the brain), similar to a hemorrhagic stroke.

Aspirin can impair function of the kidney and liver, especially in patients who already have liver and kidney disease.

Occasionally, aspirin may be toxic to the liver.

Serious side effects of aspirin, such as bleeding ulcers or intracranial bleeding, are rare (less than 1% of patients) among patients taking moderate doses of aspirin (for example, 325 mg/d). Serious side effects of aspirin should be even lower with low doses such as 75-160 mg/d. However, the actual incidence of serious bleeding with long-term use of low dose aspirin has not been clearly determined.

These serious side effects also have been associated with aspirin:

  • Thrombocytopenia (reduced blood platelets)
  • Aplastic anemia (reduced production of red blood cells)
  • Hemolytic anemia (increased destruction of red blood cells)
  • Neutropenia (reduction of white blood cells)
  • Pancytopenia (reduction of all cells in the blood
  • Agranulocytosis (reduction of one type of white blood cell)
  • Thromboembolism
  • Hypoprothrombinemia
  • Bronchospasm
  • Angioedema
  • Salicylism
  • Serious allergic reactions

Some individuals are allergic to NSAIDs and may develop shortness of breath when an NSAID is taken. People with asthma are at a higher risk for experiencing serious allergic reaction to NSAIDs. Individuals with a serious allergy to one NSAID are likely to experience a similar reaction to a different NSAID.

What are the latest recommendations on the use of aspirin in the primary prevention of heart (cardiovascular) disease?

In 2016, the U.S. Preventive Services Task Force (USPSTF) has come up with slightly modified recommendations for the primary prevention of cardiovascular disease using aspirin. Based on their review of the published data:

  • They encourage the use of aspirin in adults aged 50 to 59 years with a high risk of cardiovascular disease, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.
  • Adults who are 60 to 69 and have high risk of cardiovascular disease may receive daily aspirin based on individual circumstances. According to the recommendations, persons who are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years are more likely to benefit. Persons who place a higher value on the potential benefits than the potential harms may choose to initiate low-dose aspirin.
  • In individuals younger than 50 years of age and older than 70 years of age, the data is insufficient to recommend daily aspirin.

In 2014 the FDA reviewed all the evidence on the use of aspirin for primary prevention and did not find sufficient evidence for use of aspirin for primary prevention.

Medically Reviewed by a Doctor on 10/24/2016

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