Aspirin and Antiplatelet Medications (cont.)

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Who should be taking aspirin to prevent 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:

Doctors also consider low dose aspirin in patients at risk for atherosclerosis because they:

Who should not be taking aspirin?

Patients who should not be taking aspirin include:

  • Patients with an allergy to aspirin or other NSAIDs;

  • Patients with active ulcers, especially those with bleeding ulcers, because of the side effects of ulcers and bleeding with aspirin. Among patients who must take aspirin but have had intestinal ulcers, the lowest does 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 excreted 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;

  • Patients with advanced kidney or liver diseases since aspirin may cause toxicity to the kidney and liver;

  • Patients at risk for developing intracranial hemorrhage;

  • Some patients 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.)
Medically Reviewed by a Doctor on 9/29/2015

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