Aspirin: Is it right for you?

Prairie Doc® Perspectives week of August 28th, 2022
​Aspirin:  Is it right for you?
By Phillip Meyer, M.D.

For most people, taking a daily 81 mg aspirin to prevent stroke and heart attack is more risky than beneficial. 
Aspirin has been in use as a pharmaceutical for over 150 years making it one of our oldest.  One might assume with all this experience we would know exactly how to use it, but today’s recommendations are based on better evidence gained from better science.
Originally used to treat pain, aspirin evolved to become a cornerstone for cardiovascular protection after compelling research in the 1970s.  By the 1980s, it was recommended that almost anyone over the age of 50 take an 81 mg aspirin daily because it makes your blood clotting cells “slippery” thus helping prevent clots from forming in the arteries of your brain and heart.
Even at the low 81 mg dose, bleeding is aspirin’s most common side effect. Physicians have long accepted this risk, however, as multiple large scale research studies have established this risk as low and outweighed by its great benefits. 
This risk vs. benefit relationship has been called into question by more recent research leading to the recommendation several years ago that only those at highest risk of stroke and heart attack should take a daily aspirin.  This includes people with Diabetes, Hypertension and those who have had a stroke or heart attack in the past as well as those who have stents in their coronary or other arteries.
Research published in the April 2022 issue of the Journal of the American Medical Association is a game changing analysis confirming the benefits of aspirin are indeed outweighed by the risk of bleeding, specifically among those who have never suffered a stroke or heart attack nor have a vascular stent.  One out of every 250 people in this category taking a daily 81 mg aspirin for ten years successfully prevented a stroke or heart attack but one out of 200 suffered a major bleeding event.
In an update to their 2016 recommendations, The U.S. Preventative Services Task Force now discourages using aspirin for the primary prevention of stroke and heart attack in adults older than 60.  To clarify, those who have had a previous stroke or heart attack and/or have a vascular stent, benefit greatly from a daily aspirin and this benefit outweighs the risk of bleeding.
There are exceptions to every rule and guideline so please, as always, consult your personal physician regarding your unique situation and use of aspirin.
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Philip Meyer, D.O., is a contributing Prairie Doc® columnist. Dr. Meyer has been practicing General Internal Medicine and Hospital Medicine in Pierre since 1997. Currently Dr. Meyer practices outpatient Internal Medicine at the Pierre VA clinic where he also serves as the medical director. In addition, he is an Associate Clinical Professor for the Sanford School of Medicine and the University of South Dakota Physician Assistant Program. Follow The Prairie Doc®, based on science, built on trust, at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming live on Facebook broadcast and on SDPB most Thursdays at 7 p.m. central.