Aspirin: High Risk of Hemorrhage Outweighs Minimal Heart Benefits

by Chris Centeno, MD /

aspirin risk

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 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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8 thoughts on “Aspirin: High Risk of Hemorrhage Outweighs Minimal Heart Benefits

  1. Tiffany J Williams

    There is a dose difference of 20% between the 100mg quoted and the 81mg that many people use. What does that do to the bleeding risks ???

    1. Regenexx Team

      Tiffany,
      Because the study did not use 81mg, we don’t know. The difference between 100 and 81 is 19% but that doesn’t necessarily mean the results would be affected by 19%.

  2. BarbRiedberger

    Has there been any research done on the effects of CBD oil on stem cells?

    1. Regenexx Team

      BarbReidberger,

      We ask patients to abstain from marijuana before and after a stem cell procedure because of the tendency for it to push stem cells toward bone. So far we have no data on CBD oil. These oils do not contain THC which is the problem with bone. A reputable source would be important.

  3. AL Wekelo

    So you can’t take NSAID…you can’t take opioids…now you can’t even take aspirin…and you can’t afford regenerative medicine…so what the hell are we supposed to do with pain…..

    1. Regenexx Team

      AL,
      Sorry that it sounds like that! Thankfully, there are things for pain and inflammation that are net positives rather than net negatives. Please see: https://regenexx.com/blog/new-research-fish-oil-can-turn-bad-inflammation-into-healing/ and https://regenexx.com/blog/curcumin-for-bone-health/ and https://regenexx.com/blog/does-curcumin-work/

  4. Dane

    What are your thoughts on white willow bark? I’ve read that chemically it’s similar to aspirin but not as dangerous.

    1. Regenexx Team

      Dane,
      Willow bark contains salicylates, so the same precautions as aspirin should be taken until research has shown otherwise.

Regenexx Founder

Chris Centeno, M.D. is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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