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.

Who should not take aspirin to prevent heart attacks and strokes?

People who should not take aspirin include:

  • People with an allergy to aspirin or other NSAIDs.
  • People with active ulcers, especially those with bleeding ulcers, because of the side effects of ulcers and bleeding with aspirin. Among People who must take aspirin but have had intestinal ulcers, the lowest doses of aspirin should be used only after the ulcers heal. It should also be taken together with a proton pump inhibitor such as pantoprazole (Protonix), esomeprazole (Nexium), rabeprazole (Aciphex), or lansoprazole (Prevacid, Prevacid SoluTab) to decrease the risk of recurrent ulcers.
  • Pregnant women and nursing mothers (since aspirin is secreted into breast milk).
  • Teenagers and children with the flu or chickenpox because of the associated risk of Reye's syndrome, a serious disease of the liver and nervous system that can lead to coma and death.
  • People with advanced kidney or liver diseases since aspirin may cause toxicity to the kidney and liver.
  • People at risk for developing intracranial hemorrhage.
  • Some people undergoing elective surgery or procedures. (Patients taking aspirin should discuss with their doctors whether to stop aspirin for several days to up to two weeks before surgery and procedures to avoid excess bleeding.)

According to the FDA there is no good evidence supporting the use of aspirin to prevent a heart attack or stroke in people who have a low risk of developing a heart attack or stroke.

When is aspirin used for preventing and treating heart attacks and strokes?

Aspirin is widely used either alone or in combination with other antiplatelet agents to prevent blood clots from forming in arteries. Aspirin is used specifically in several situations including:

  1. Aspirin often is prescribed in moderate doses (160-325 mg/day) for people who are having heart attacks to limit the extent of damage to the heart's muscle (by preventing further blood clot formation in the blood vessels of the heart and reduction of blood flow), prevent additional heart attacks, and improve survival.
  2. Aspirin often is prescribed to patients undergoing surgery to open or bypass blocked arteries, including percutaneous transluminal coronary angioplasty (PTCA) with or without placement of coronary stents and coronary artery bypass surgery (CABG). Aspirin also is prescribed on a long-term basis to prevent clotting in the stents and/or the bypassed blood vessels.
  3. Aspirin often is prescribed in low doses (75-160 mg/day) on a long-term basis to patients with prior heart attacks or strokes and to patients with TIAs (transient ischemic attacks or mini-strokes) and exertional angina to prevent heart attacks and ischemic strokes.
  4. Aspirin is prescribed in moderate doses (160-325 mg/day) to patients who are having unstable angina to prevent heart attacks and improve survival.
  5. Aspirin is prescribed in moderate doses (160-325 mg/day) to selected patients who are having ischemic strokes to limit damage to the brain, prevent a second stroke, and improve survival.
Medically Reviewed by a Doctor on 10/24/2016

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