Health Update

By Tyrone M. Reyes, M.D.

Aspirin has long been known to relieve fever, aches, and pains. Today, it has also gained a reputation as a drug that can lower the risk of heart attack and clot-related stroke. Thousands of adult Filipinos now take a daily dose of aspirin. Yet this type of therapy isn’t right for everyone; and others who need aspirin aren’t taking it.

So, if you’re currently taking a daily aspirin, or wondering if you should, here are the latest recommendations from the experts.

How Aspirin Prevents A Heart Attack Or Stroke

Aspirin reduces the clumping action of your blood’s clotting cells (platelets), which helps keep blood flowing to your heart and brain. Platelets normally clump together, or clot, at the site of a cut or a wound. This action seals openings in the blood vessels and stops bleeding. But clots can also form within blood vessels that supply your heart and brain with blood. If these blood vessels are already narrowed from an accumulation of fatty deposits (atherosclerosis), a blood clot can quickly block an artery and cause a heart attack or ischemic stroke.

Aspirin Works Differently In Men And Women

Although early studies on aspirin therapy involved men, more recent studies have focused on women. These studies have found that there do appear some differences between the sexes when it comes to the role aspirin plays in the prevention of a first (primary) heart attack or stroke.

In the past, studies showed that among men, aspirin provided primary heart attack prevention but had mixed results when it came to reducing the risk of a first stroke. By 2005, it seemed that the same couldn’t be said for women. That year, the Women’s Health Initiative (WHI) released results from a 10-year study of 40,000 women which found that aspirin didn’t prevent first heart attacks, but it did reduce the risk of stroke.

Since then, additional information has been published on aspirin therapy. Those studies reached the same overall conclusions, as did the WHI study. It found that in women, aspirin provided prevention of a primary stroke but didn’t reduce the risk of a first heart attack. In men, aspirin provided primary heart attack prevention but didn’t reduce the risk of a primary stroke.

Should You Take A Daily Aspirin?

People should take steps to reduce their risk of heart disease and stroke. After all, these two conditions are among the top causes of death and disability in most parts of the world, including the Philippines. However, that doesn’t mean that everyone is a good candidate for daily aspirin therapy.

Much of the decision-making process depends on your risk of heart attack and stroke. Therefore, it’s important to be aware of the risks and to discuss your risk level with your doctor. Factors that increase your risk include older age, a family history of heart attack and stroke, smoking, uncontrolled high blood pressure, high cholesterol, and diabetes.

If you have a condition that increases your risk of heart attack or stroke, have multiple or uncontrolled risk factors or have had prior cardiovascular events, current guidelines recommend that you should be on daily aspirin therapy. However, it’s important not to start this therapy without consulting your doctor. The reason: Aspirin’s possible side effects.

Aspirin can cause side effects such as nausea, vomiting, heartburn, and a rash. Rarely, more serious side effects may occur, including swelling of the eyes, lips, tongue or throat, wheezing and hoarseness, a rapid heart rate and breathing, and ringing in the ears (tinnitus) or loss of hearing. Contact your doctor immediately if you experience any of these effects, or any unusual reaction to aspirin use. Other side effects, related to certain medical conditions and drug interactions, also bear watching.

Who Should Avoid It?

The occasional aspirin, or daily low-dose aspirin therapy under medical supervision, is safe for most adults, but the drug can have serious side effects in certain individuals. Aspirin is a blood thinner, so a bleeding tendency, such as hemophilia (a condition where the blood is slow to clot) is the main contraindication for its use. This also means that if you take another blood-thinning drug, such as warfarin (Coumadin), you shouldn’t take aspirin.

Aspirin may also increase the risk of stomach ulcers, so it should be avoided if you suffer from these or from gastritis (inflammation in the stomach). An allergy to aspirin is also a contraindication, though it may not be clear you have one until you take the drug. Those with asthma, chronic nasal congestion or a constantly running nose, or nasal polyps, are more likely to have an allergy, and tinnitus often is a prime indication of aspirin allergy if it begins when you start daily aspirin therapy.

What Is The Best Dose?

Lower doses of aspirin have been shown to work as well as full-strength doses in preventing heart attack and stroke. Low doses also may reduce the risk of bleeding complications. A low-dose is usually considered to be 81 milligrams (mg) or one “baby” aspirin. A full-strength dose is 325 mg, or what one regular aspirin provides. Your doctor may recommend a dose anywhere between these two amounts, depending on your needs.

Taking aspirin with a protective coat (enteric-coated) that helps it get through the stomach without being broken apart sounds like a great idea for preventing stomach irritation. But it doesn’t work. Aspirin in the bloodstream irritates the stomach just as much, and there’s some evidence that not all of the aspirin in a coated pill gets into the circulation.

If you’ve already had a heart attack or stroke or are resistant to the beneficial effects of aspirin, your doctor may suggest supplementary aspirin therapy with another clot-preventing drug, such as clopidogrel (Plavix). Clopidogrel may even be suggested as an alternative drug therapy, particularly if you’re allergic to aspirin or can’t tolerate its side effects.

If you’re currently on aspirin therapy, be aware that ibuprofen can counteract aspirin’s benefits. It’s best to take aspirin in the morning, then wait at least 30 minutes before taking ibuprofen. If that’s impossible, try to delay taking aspirin for at least eight hours after taking ibuprofen.

Important Precautions

If you’re scheduled to have surgery, tell your doctor if you take a daily aspirin — you may need to stop taking it prior to surgery to reduce your risk of bleeding. Since aspirin can exacerbate stomach ulcers, tell your doctor if you ever had one of these and also if you are prone to heartburn. He/she also needs to know if you have hemophilia, or kidney or liver disease. Avoid excessive alcohol intake (stick to one drink a day, maximum) while on daily aspirin therapy since alcohol can act as a blood thinner.

Acetaminophen (Tylenol) and ibuprofen (Advil, Alaxan, Brufen, etc.) are the main alternatives to aspirin for the purpose of reducing pain and fever. Acetaminophen is less likely to irritate the stomach but isn’t as efficient at soothing inflammation. Ibuprofen works in a similar way to aspirin, but neither it nor acetaminophen carries the same heart benefit as aspirin.

Aspirin During A Heart Attack

If you’re experiencing a heart attack, aspirin can save your life. This is true even if you’re currently taking daily aspirin therapy. Experts say it’s best to take two to four low-dose, or “baby” aspirin, or one regular- strength aspirin during a heart attack. Chewing up the aspirin is recommended because it speeds up the absorption process.

Beyond Aspirin

Aspirin lowers the chances of having a first heart attack or stroke by 25 percent, which is great, but it also means that you can’t rely on aspirin alone to protect you. If you’re really serious, there’s a lot more you can do. The combination of not smoking, maintaining a healthy diet, exercising daily, and drinking alcohol in moderation lowers the risk of having a heart attack or stroke between 50 percent and 80 percent.

As one wag said, if you plan to take aspirin every day to prevent a heart attack or stroke, take it for a long walk before you swallow it!

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References:

• Aspirin to reduce stroke risk in women. Circulation: Cardiovascular Quality and Outcomes, March 2009

• Aspirin for primary prevention. Annals of Internal Medicine, March 17, 2009

Source:Philstar.com