Q: I am a 71-year-old active female. Three years ago I had a TIA. When I was unable to tolerate Aggrenox, the neurologist told me to take one 325 mg aspirin a day, which I have done ever since. This was followed by a television report that indicated aspirin has been shown to help prevent cancer, but one doctor indicated that the side effects of this [therapy] are stomach bleeding and stroke. What?? Can you explain to me why I am taking this to avoid a second stroke and now learn it can cause a stroke? I also presently take 75 mcg Levothyroxine, 20 mg Pravastatin, 20 mg Lisinopril, and a multivitamin. I weigh 130 pounds. A cardiologist recently told me low-dose aspirin would be just as effective [as a 325 mg] but I’ve been afraid to cut back. Your thoughts?
Thank you for your wonderful column which I never miss.
A: It’s long been understood that a daily aspirin may lower your risk for a heart attack. The issue, however, is whether the regimen is right for everyone. Each primary health care provider should discuss that situation with his or her patient because of each medical history, drug regimen and other complications that could contraindicate its use.
A person should take a daily aspirin only if his or her physician recommends it. It is not an across-the-board recommendation because some individuals may have a history of internal bleeding, may be on an anti-coagulant already, or may have an allergy that would make the practice contra-indicated. Aspirin interferes with the body’s normal clotting action. When a person bleeds, the blood’s platelets build up at the site of the wound, helping form a seal or adhesive bandage effect to help stop the bleed. Having said this, clotting can also occur within the vessels that supply the heart with blood. If those vessels are already narrowed because of conditions such as atherosclerosis, the deposit may become so large that it occludes vital blood flow. When that happens in the heart, it may cause a heart attack. Now, here’s the tricky part that you are concerned about – choosing to stop taking aspirin therapy. This step can increase the risk of having a stroke and the risks are even greater with a history of cardiac event or in those who have had a stent inserted.
As has been mentioned in this column in the past, there are a number of medications, both prescription and over-the-counter forms, that act as anti-coagulants or as most people call them, blood thinners. NSAIDS (non-steroidal anti-inflammatory medications) such as ibuprofen have an effect on the clotting process. So, if you take an aspirin for a headache and follow up with Motrin, Aleve, or Advil, you can increase your risk of having a bleed. Other medications with a crossover effect include corticosteroids, some but not all anti-depressants and dietary supplements such as evening primrose oil, ginkgo and fish oil.
Side effects from a simple aspirin can include having an allergic reaction, tinnitus (ringing in the ears from taking an excessive amount of aspirin), stroke, and gastrointestinal bleed. I’m sure at this stage you are shaking your head in disbelief and wonder how you’ve managed to survive. This is not a cause for alarm but I recommend you speak with your physician because there are some medical conditions such as having an artificial heart valve in which a combination of aspirin therapy and an anticoagulant may be endorsed. I side with your cardiologist who feels an 81 mg aspirin daily might be appropriate, because the effect to decrease platelets from forming a clot is just as good with 81 mg as with more. It will also cause less stomach and intestinal irritation and therefore, less change of stomach or intestinal bleeding. The bottom line for a patient with a previous TIA, no history of ulcers or other bleeding problems is that low-dose aspirin has been shown to be more effective than placebo, and the benefit generally outweighs the risk.
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