The Benefits and Risks of Daily Aspirin

Published: September 02, 2021
Revised: February 16, 2023
T Cindy Yang
By Tianrui "Cindy" Yang, Pharm.D., BCPS

Daily aspirin therapy, where you take a low dose of aspirin every day, may reduce your risk of heart attack or stroke. Aspirin works by interfering with your blood’s clotting action. When clots form in your heart or brain and block the blood flow to these areas, heart attacks or strokes occur. By interfering with clot formation, aspirin can help to prevent these conditions.

What is daily aspirin therapy?
Daily aspirin therapy is recommended for certain patients to reduce the risk of forming blood clots that can cause future health problems. A low dose of daily aspirin can range from 81 mg to 325 mg depending on your condition and other medications you may be taking. However, daily aspirin therapy does come with some risks. Always talk to your doctor to find out if daily aspirin therapy is right for you and what dose you should take.

Who would benefit from daily aspirin therapy?
It was previously believed that daily aspirin therapy is an easy way to prevent heart attacks and strokes for everyone; however, a series of recently published studies proved otherwise. If you have already had a heart attack or a stroke, you should remain on daily aspirin therapy as recommended by your doctor to prevent a second event.

However, if you have not previously had these conditions, the potential benefit of aspirin is largely offset by the risk of bleeding, especially in adults older than 60 years of age. In fact, some of the studies showed an increased likelihood of death for people who received low dose aspirin compared to those that did not.

While the benefit with daily aspirin does not seem to outweigh the bleeding risks, it may still be beneficial for some patients with a very high risk for heart attacks or strokes but relatively low risks for bleeding.

Before starting to take daily aspirin, talk to your doctor first to discuss the risks and the benefits.  

What are the risks of taking daily low dose aspirin?
Aspirin can increase the risk of internal bleeding, such as bleeding in the brain or stomach especially in older adults. Internal bleeding signs and symptoms include black, tarry stools, bruises that get bigger over time, blood in the urine, or a nosebleed that doesn’t stop after applying pressure. If the bleeding is severe, weakness, dizziness, or shortness of breath can also occur. If any of these symptoms occur, you should seek medical attention.

In addition to bleeding, aspirin can also cause inflammation of any stomach ulcers leading to stomach pain. However, if this is the issue and your doctor prescribed you daily aspirin, using an enteric-coated aspirin may help with these side effects. Enteric-coated medications can resist the acidic gastric fluids and release the active medication content in the intestine instead of the stomach. This can help prevent stomach ulcers and stomach inflammation, but it will not help prevent internal bleeding that can occur with aspirin use.

Does aspirin have any interactions with other medications?
Aspirin can increase the risk of bleeding, so aspirin should be used with caution if you are taking other medications that also carry an increased risk of causing bleeding. Medications that can cause bleeding include all blood thinners such as warfarin, apixaban, rivaroxaban, dabigatran, edoxaban, and betrixaban.

Over-the-counter medications such as naproxen (Aleve) and ibuprofen (Motrin, Advil) can increase the risk of bleeding as well. Be sure to talk to your doctor or pharmacist if you are taking any combination of aspirin, a blood thinner, or pain reliever.

Daily aspirin therapy may be used to reduce the risk of heart attacks and strokes. Daily aspirin therapy may be right for you if you have already had a heart attack or a stroke. However, daily aspirin therapy does come with some risks. Always talk to your doctor or pharmacist before starting daily aspirin therapy to weigh the benefits and the risks. If you have any questions, talk to your doctor or your pharmacist.

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