Aspirin or Acetylsalicylic Acid (ASA) is probably one of the few drugs that has stood the test of time with over 100 billion tablets (or 35,000 tonnes) being dispensed every year, worldwide.
It is recorded that the Egyptians used extracts from the Willow tree to relieve general aches and pains around 3000 – 1500 BC. Hippocrates, also used natural aspirin from willow leaf tea to help women with pain during childbirth in 400 BC – even though he may not have known that this may have increased the risk of bleeding for both the mother and baby.
This leads us to aspirin’s main use in medicine today – to thin the blood and stop clots (stroke) starting in the arteries of the heart, neck and brain. This is a major cause of sudden death in people with a history of high blood pressure, angina or heart attack, and previous stroke or transient ischemic attack (which is like a mini stroke). Of course, things like smoking, being overweight, poor diet, little or no exercise, alcohol, and diabetes make the chances of getting a stroke much worse.
In fact, more than two drinks of alcohol every day is more likely to cause stroke in some people than high blood pressure and diabetes – so making good changes to your lifestyle will help here.
In people with these heart and blood flow problems, an aspirin (100 mg) a day is likely to reduce visits to the emergency department of your local hospital – and yes, in a sense it helps to keep the doctor away.
There is also some evidence now from the 2016 United States Preventative Task Force that daily Aspirin (75 to 100 mg) may prevent heart and blood flow problems for people aged between 50 and 59 years of age who have a high risk (greater than 10%) of developing stroke, even for the first time (also called primary prevention).
All the same, there are some special “ifs and buts” here for people in this age group (50 and 59 yrs);
- You are not at increased risk of bleeding
- You expect to live more than 10 years
- You are willing to take aspirin every day for 10 years
- Your risk of developing cardiovascular disease (heart and blood circulation problems) is greater than 10%
How do you work out your risk of cardiovascular disease?
It is possible to calculate your heart health risk provided you know some basic information about your health. See http://checkcvd and check with your doctor first before making the choice to take aspirin every day!
There is also some good evidence that daily aspirin (75-100 mg) may help with colorectal cancer over the long term (10 years or so) by;
- Decreasing the number of people with large bowel cancer by 24%
- Reducing the number of deaths from large bowel cancer by 34%
Recent studies are now also looking at a possible benefit of low dose aspirin in breast cancer (mainly HER2-negative type) for women and prostate cancer for men.
It is important to remember that there may also be many side effects for some people who take low dose aspirin every day, including;
- Bleeding, especially the stomach and bowel for people over 60 yrs who also have diabetes.
- Allergy which may cause breathing problems (asthma and rhinitis) and rash
- Nausea and vomiting
- Anaemia which is less red blood cells or haemoglobin (oxygen carrier) in the blood
Of course, aspirin may also interact with many other medicines or drugs such as:
- Alcohol – increases irritation in stomach
- Warfarin – increases risk of bleeding
- Sodium Valproate in epilepsy – also increases risk of bleeding with aspirin.
- Antacids – regular use may reduce effect on aspirin in thinning the blood.
- Antidepressants – may also increase bleeding with aspirin.
Should you take aspirin every day?
It depends very much on the benefit (reduced stroke or bowel cancer) and the risk (more bleeding) for the individual patient.
If you are not sure, talk to your doctor or pharmacist, or talk to both – and a Home Medicine Review might just help you decide if daily aspirin is right for you.
Emmanuel Pippos, Consultant Pharmacist.