More than 4,000 years ago, the Sumerians treated pain with willow bark extract. Centuries later, German chemist Frederich Bayer created the synthetic version: acetylsalicylic acid, dubbed aspirin. Marketed as “the wonder drug,” the 325–milligram tablet (Bayer, Anacin) became a popular (and cheap) remedy for sprains, headaches and fever. After studies in the 1980s showed that just 81 mg protected against heart attack and stroke, nearly one-fifth of Americans —that’s 65 million—began taking low doses. Aspirin has remained one of the most commonly purchased over-the-counter medications in the United States.
Aspirin is a non-steroidal anti-inflammatory drug (NSAID), in the family that includes Advil and Aleve. These medications block the body’s production of prostaglandin, the hormone that causes inflammation. Aspirin works well for moderate pain and fever; its anti-inflammatory properties may lower colon cancer risk. Prostaglandins help with blood clotting, too: Without them, our platelets—the blood cells crucial to coagulation—won’t stick together, and we bleed more easily.
Often called a blood thinner, aspirin stops clots from blocking the blood flow through the tiny arteries supplying our heart and brain, making it helpful in thwarting a heart attack or stroke. But because the gut’s delicate superficial blood vessels bleed easily, aspirin can also increase the chance of a serious gastrointestinal hemorrhage.
The safety of daily low–dose aspirin has been debated for decades: Does the benefit of heart attack and stroke prevention outweigh the risk of a major hemorrhage? In 2018, three large U.S. studies answered the question. Taking aspirin as little as twice a week increases the chance of a gut or brain bleed by 30%; the higher the dose, the worse the risk. The chances doubled for seniors over 70.
The American Cardiology College and the United States Preventive Services Task Force updated their guidelines in 2022: Those aged 60 and older who have never had a heart attack or stroke should not take daily low–dose aspirin. High risk individuals between the ages of 40 and 59 (like diabetics who smoke cigarettes) may still benefit, but must consult their physician. Low–dose aspirin remains a cornerstone of therapy at any age for those who have already had a heart attack, bypass, stent or stroke.
Of the 30 million Americans now taking aspirin regularly, a quarter are doing so without the knowledge of their medical provider. Never initiate daily 81-mg aspirin without consulting your doctor, and don’t stop low-dose therapy without checking with your physician, because that may trigger a heart attack.
Taking occasional aspirin for a headache or toothache is still an option, providing there are no contraindications. Don’t use aspirin if you have a history of stomach ulcers; take blood thinners like warfarin; are allergic to NSAIDs; or are over 65 or under 18. (The FDA banned aspirin use for children and teens due to Reye’s syndrome, potentially fatal liver and brain swelling.) Ask your pharmacist about potential drug interactions: even supplements like evening primrose and gingko can enhance aspirin’s anticoagulant effect. Be aware that coated aspirin like Ecotrin takes longer to dissolve but has the same risks.
If you’re wondering if aspirin is a choice for you, ask your doctor.
Mary Jenkins recently retired after nearly 40 years as a family practice physician in New York state.