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 take aspirin to prevent and treat heart attacks and strokes?

Even though aspirin is available without a doctor's prescription and has been used safely for many years by patients for fever and pain, patients should NOT take aspirin on a long-term basis without consulting with their doctor.

Aspirin prevents blood clots from forming inside arteries affected by atherosclerosis, but aspirin does not prevent atherosclerosis. Other measures (losing excess weight, controlling high blood pressure and diabetes, lowering LDL cholesterol, increasing HDL cholesterol, and stopping cigarette smoking) are necessary to prevent atherosclerosis.

Most doctors now recommend low doses of aspirin long-term for patients with advanced atherosclerosis for secondary prevention purposes. Such patients include those with:

  • Prior heart attacks
  • Prior strokes
  • Exertional and unstable angina
  • TIAs (transient ischemic attack, mini-stroke)
  • Vascular procedures such as PTCA and CABG

People who have not had a heart attack or stroke but have a high risk for developing a heart attack or stroke should also receive long-term low dose aspirin. For example, the American Diabetes Association recommends that people 50 years of age or older with type 1 or type 2 diabetes who have a high risk for heart attacks or strokes because of hypertension, smoking, a family history of stroke or heart attacks, or abnormal lipid levels should receive aspirin daily. Adults age 50 to 59 with a high risk of cardiovascular disease may also be considered for low dose aspirin treatment.

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.

Medically Reviewed by a Doctor on 10/24/2016

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