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Aspirin, the common pain reliever that has been in our
medicine cabinets for more than a century, also has a talent for prevention.
Aspirin prevents blood clots from forming in your arteries. This can prevent a heart attack or stroke.
For people who have had a heart attack: Aspirin can help prevent a second heart attack. Your doctor has probably already prescribed low-dose aspirin for you.
For people who have had a stroke: Aspirin can help prevent a second stroke or a transient ischemic attack (TIA), which is often a warning sign of an impending
For people who have never had a heart attack or stroke: Talk to your doctor before you start taking aspirin every day. Aspirin may reduce your chance of having a heart attack or a stroke if you have coronary artery disease or certain risk factors, such as diabetes, high blood pressure, high cholesterol, or smoking. If you have a higher risk for a heart attack or stroke, aspirin will have even more benefit for you.
Aspirin may also be used by people who:
For help on the decision to take low-dose aspirin, see:
Doctors use different guidelines to decide who should take daily aspirin. But no matter which guideline your doctor follows, he or she will look at your health and at your risk for a heart attack or stroke. Then you and your doctor will balance the benefits and the risks of taking a daily aspirin to see if a daily aspirin is right for you.
If you have a relatively low risk for a heart attack or stroke, the benefits of preventive aspirin therapy may be
outweighed by the increased risk of bleeding problems.
Your doctor can help you know your risk of having a heart attack or stroke and the risk of bleeding from aspirin.
People who have certain health problems shouldn't take aspirin. These include people who:
If you think you are having a
stroke, do not take aspirin because not all strokes are caused by clots. Aspirin could make some
Gout can become
worse or hard to treat for some people who take low-dose aspirin.
If you can't take aspirin, your doctor may have you take clopidogrel (Plavix)
to help prevent a heart attack or a stroke.
If you take an anticoagulant, such as warfarin (Coumadin), talk with your doctor before taking aspirin, because taking both medicines can cause bleeding problems.
Drinking 3 or more alcoholic drinks every day while
taking daily aspirin increases your risk for liver damage and stomach bleeding.
If your doctor recommends aspirin, limit or stop alcohol usage.
Before you have a surgery or procedure that may cause bleeding, tell your doctor or dentist that you take aspirin. Aspirin may cause you to bleed more than usual. He or she will tell you if you should stop taking aspirin before your surgery or procedure. Make sure that you understand exactly what your doctor wants you to do.
Do not suddenly stop taking
aspirin without talking to your doctor first. Talking to your cardiologist first is
especially important if you have had a
stent placed in a
Tell your doctor if
you notice that you bruise easily or have other signs of bleeding. These include bloody or black stools or prolonged bleeding from cuts or scrapes.
Aspirin should not be taken with many prescription and over-the-counter
drugs, vitamins, herbal remedies, and supplements. So before you start aspirin
therapy, talk to your doctor about all the drugs and other remedies you
nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen and naproxen, relieve pain and inflammation much like aspirin does,
they do not affect blood clotting in the same way that aspirin does. Do not
substitute NSAIDs for aspirin. NSAIDs may increase your risk for a heart attack or stroke.
If you need both aspirin and a pain
reliever every day, talk to your doctor about what pain reliever you should
take. If you take uncoated aspirin and ibuprofen at the
same time, the aspirin may not work as well to prevent a heart attack. You may
be able to use acetaminophen instead of ibuprofen to treat your pain. But if
ibuprofen is your only option, avoid taking it during the 8 hours before and the 30 minutes after your
aspirin dose. For example, you can take ibuprofen 30
minutes after your aspirin dose. If you take ibuprofen once in a while, it does
not seem to cause problems.
Experts do not know if NSAIDs other
than ibuprofen interfere with uncoated aspirin. Also,
experts do not know if people who take a daily coated
aspirin should be concerned about ibuprofen or other NSAIDs interacting with
the aspirin. Talk to your doctor if you take these medicines every day.
For more safety tips, see:
Your doctor will recommend a dose of aspirin and how often to take it. Most people take aspirin every day to help prevent a heart attack or a stroke, but others might take aspirin every other day.
Low-dose aspirin (81 mg) is the most common dose used to prevent a heart attack or a stroke.
But the dose for daily aspirin can range from 81 mg to 325 mg. One low-dose aspirin contains 81 mg. One adult-strength aspirin contains about 325 mg.
For low-dose aspirin therapy, do not take medicines that combine aspirin with other ingredients such as
caffeine and sodium.
Low-dose aspirin seems to be as effective in preventing heart
attacks and strokes as higher doses.
Take aspirin with food if it bothers your stomach.
Aspirin protects you from having
a clot-related stroke in the same way it protects you from having a
Aspirin slows the blood's
clotting action by reducing the clumping of platelets. Platelets are cells that
clump together and help to form blood clots. Aspirin keeps platelets from
clumping together, thus helping to prevent or reduce blood clots.
During a heart attack, blood clots form in an already-narrowed artery and
block the flow of oxygen-rich blood to the heart muscle (or to part of the
brain, in the case of stroke). When taken during a heart attack, aspirin slows
clotting and decreases the size of the forming blood clot. Taken daily,
aspirin's anti-clotting action helps prevent a first or second heart
Other Works Consulted
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Antithrombotic drugs (2011). Treatment Guidelines From The Medical Letter, 9(110): 61–66.
Eikelboom JW, et al. (2012). Antiplatelet drugs: Antithrombotic therapy and prevention of thrombosis, 9th ed.–American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): e89S–e119S.
Goldstein LB, et al. (2010). Guidelines for the primary prevention of stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. Published online December 2, 2010 (doi: 10.1161/STR.0b013e3181fcb238). Also available online: http://stroke.ahajournals.org/content/42/2/517.full.
Paikin JS, Eikelboom JW (2012). Aspirin. Circulation, 125(10): e439–e442.
Pignone M, et al. (2010). Aspirin for primary prevention of cardiovascular events in people with diabetes: A position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Circulation, 121(24): 2694–2701.
Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.
Steinhubl SR, et al. (2009). Aspirin to prevent cardiovascular disease: The association of aspirin dose and clopidogrel with thrombosis and bleeding. Annals of Internal Medicine, 150(6): 379–386.
U.S. Food and Drug Administration (2006). Concomitant
use of ibuprofen and aspirin: Potential for attenuation of the anti-platelet
effect of aspirin. Food and Drug Administration Science Paper. September 8, 2006. Available online:
U.S. Preventive Services Task Force (2009). Aspirin for the prevention of cardiovascular disease. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.htm.
Vandvik PO, et al. (2012). Primary and secondary prevention of cardiovascular disease: Antithrombotic therapy and prevention of thrombosis, 9th ed.– American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): e637S–e668S.
Current as of:
March 12, 2014
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & Robert A. Kloner, MD, PhD - Cardiology
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