Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS) make platelets in the blood more slippery, allowing for blood to more freely move through arteries.

You've likely heard that Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS) may help prevent clotting in blood vessels.  But recently, the United States Preventative Services Task Force recommend changes for using aspirin as a primary prevention of heart attacks and stroke. So, what does this mean for you, and should you continue or discontinue using Aspirin as a preventative measure? University of Minnesota College of Pharmacy professors Dr. Robert Straka and Dr. Anne Schullo-Feulner discuss the new changes.

How can aspirin help prevent heart attacks and stroke? How does it work?

Heart attacks or stroke often result from arteries becoming blocked and unable to deliver oxygen-rich blood to parts of the heart or brain.

Aspirin prevents blockages by reducing the production of a chemical called thromboxane, a chemical that promotes clotting by making blood platelets stick together. With less thromboxane available, platelets become less likely to clot together, allowing blood to flow freely throughout the body.

Isn’t it important that our blood be able to clot? Isn’t clotting a good thing?

Platelet clotting is essential to prevent excessive bleeding from conditions such as ulcers or injuries, but too much clotting can obstruct arterial blood flow, leading to heart attacks or strokes. Finding the right balance is critical. It turns out aspirin plays a key role in maintaining this balance, but the issue of who can safely take aspirin and who should avoid the medication is complex.

Why did the United States Preventative Services Task Force recently recommend changes for using aspirin as a primary prevention of heart attacks and strokes?

There are some common risks involved when taking aspirin, even if you’re otherwise healthy and haven’t had a previous cardiac event. The Task Force recommendation has become more specific in terms of both age and gender to assist practitioners in determining when the benefit of taking aspirin outweighs the risk.

While the benefit of aspirin as a secondary prevention (preventing a recurrence of heart attack or stroke) is clear, the Task Force is basically saying that its use as a primary prevention (preventing the first heart attack or stroke) requires a close look and shouldn’t be uniform for everyone.

How will health care providers use the new recommendations?

For both sexes, providers will utilize risk factors such as blood pressure, cholesterol level, and smoking status to calculate an overall risk score that can then be utilized with the Task Force recommendation to determine at what age the benefit of aspirin use outweighs risk for a specific patient.

What do the new Task Force recommendations mean if you’re a woman?

Based on numerous studies, the benefits of aspirin use in women and men appear to differ.

Women ages 55-79 should take medications like aspirin when the benefits of preventing stroke outweigh the potential harm of gastrointestinal bleeding or bleeding of the brain. Women under 55 or older than 79 years are not encouraged to take these medications for primary prevention.

What do the new Task Force recommendations mean if you’re a man?

Men ages 45-79 should take medications like aspirin when the benefits of preventing heart attacks outweigh the potential harm of gastrointestinal bleeding or bleeding of the brain. Men under 45 or over 79 years of age are not encouraged to take these medications for primary prevention.

Should I take aspirin?

For most people, the answer isn’t a simple “yes” or “no.”

Things that need to be taken into account include other medication use, family history of heart attack or stroke, age, blood pressure, and history of gastrointestinal bleeding. Before incorporating aspirin into your daily routine, consult your primary physician or other health care professional who is familiar with the application of these new guidelines and your specific medical conditions.

What are some of the risks associated with aspirin?

Risks when taking aspirin include gastrointestinal bleeding and bleeding in the brain (hemorrhage). Bleeding in the stomach or brain occurs infrequently, but often enough that those individuals who are likely to experience these risks when taking aspirin chronically for primary prevention should avoid it.

The risk varies with both age and sex of an individual, and patients should always consult with their physician.

 --- Emily Jensen