Aspirin: High Risk of Hemorrhage Outweighs Minimal Heart Benefits
It seems like every patient over 40 I see is taking, or has been told to take, a baby aspirin a day to protect them from a heart attack. This seems like such an innocuous thing, a tiny white pill given to babies. However, does the risk of this tiny thing outweigh the benefit?
What Is Aspirin?
Acetylsalicylic acid, or aspirin, is the original nonsteroidal anti-inflammatory medication (NSAID). It was a folk remedy where ancient peoples would boil willow bark and use it to help fevers. Aspirin’s use commercially as a drug to treat pain, fever, and inflammation dates back to the late 1890s and was the primary drug for these conditions until the 1950s when acetaminophen and ibuprofen were developed. The difference with aspirin, however, is that due to its anti-blood-clotting agents (its ability to “thin the blood”), it is often recommended in low doses as a daily preventative, for example, for those who might be at risk for heart disease or a heart attack. Many have generally come to accept a daily dose of aspirin or baby aspirin as a therapy to staying heart healthy. A recent study, however, challenges the degree of efficacy of aspirin on heart disease and expands aspirin risk concerns of bleeding issues associated with the drug. Let’s review.
Aspirin Heart Benefits Minimal and Aspirin Risk of Hemorrhage Major
The new study was a large randomized controlled trial consisting of over 19,000 participants (aged 70 and older) over a four-year period. Participants received either a daily low dose (100 mg) of aspirin or a placebo and did not know which they received. The results? Researchers found that for every 1,000 person-years there were 10.7 events of fatal or nonfatal cardiovascular disease (e.g., heart attack, stroke, heart failure, coronary heart disease); in the placebo group, this number was only slightly higher at 11.3 events per 1,000. This wasn’t a significant difference. In addition, for every 1,000 person-years, there were 8.6 events of fatal or nonfatal major hemorrhage (e.g., hemorrhagic stroke, intracranial bleeding, etc.); this number was significantly lower in the placebo group, at 6.2 per 1,000.
The study concluded that a daily low dose of aspirin was associated with a higher risk of major hemorrhage with no significant lowered risk of heart disease. So while there is a minimal chance that taking the recommended daily low dose (100 mg) of aspirin as a preventative will ward off heart disease, it’s about twice as likely it will result in a major bleeding event. What does the mean? Quite simply, the aspirin risk of hemorrhage, in most cases, outweighs the minimal heart benefits.
What about other nonsteroidal anti-inflammatory drugs (NSAIDs)? Can you just substitute the aspirin with ibuprofen for example? Definitely not! First, other NSAIDs aren’t associated with an anti-clotting effect, which is the reason daily aspirin is recommended in the first place. And, second, these NSAIDs are accompanied by many dangerous side effects. Let me explain.
NSAIDs Riddled with Dangerous Side Effects
Ibuprofen (e.g., Advil), celecoxib (e.g., Celebrex), diclofenac (e.g., Voltaren), naproxen (e.g., Aleve)…it doesn’t matter what the NSAID is, or whether it’s prescription or over the counter, all NSAIDs are bad news. Let’s review a handful of reasons to stay away from these dangerous drugs:
- The popular prescription diclofenac seems to lead the NSAID pack in dangerous risks associated with fatal and nonfatal heart events as well as gastrointestinal bleeds. More studies have been done dating back years on the dangers of diclofenac compared to other NSAIDs.
- Ibuprofen may result in male infertility.
- Despite the fact that many take NSAIDs to relieve inflammation with arthritis, NSAIDs may actually be worsening arthritis damage in the process.
- NSAIDs may have a damaging effect on stem cells, causing them create defective cartilage. Or NSAIDs, in the case of tendon tissue, may cause stem cells to become fatty tissue instead of normal tendon cells .
- Just one week of taking NSAID may increase the risk of heart attack risk by 50%.
The upshot? Turns out that little tiny pill is not going to help your heart, but may cause other issues. Like anything else, in medicine, what once was dogma is overthrown by new information!
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