UAB Medicine News


Aspirin Therapy Guidelines

The use of daily aspirin to fight cardiovascular disease has been a long-standing debate between medical professionals. Because of the increased risk of gastrointestinal bleeding, aspirin, especially in high doses, is not always recommended for every patient. However, U.S. experts now state that lower doses appear to be at least as effective as higher doses and safer at preventing heart attack in men and stroke in women.

Current Aspirin Guidelines 
The U.S. Preventive Services Task Force guidelines are tailored to match age and gender. Among the recommendations: Men aged 45 to 79 should take aspirin if the chances of preventing a heart attack outweigh the chances of gastrointestinal bleeding (GI). Women aged 55 to 79 should take the drug if the chances of reducing ischemic stroke outweigh the risks of GI bleeding.

Dr. Michael LeFevre, a member of the task force, says that more information was available from the Women’s Health Initiative recently that allowed them to make aspirin recommendations by gender. Aspirin seems to be more effective in men for preventing heart attack, but, in women, better at preventing stroke. 

However, UAB Cardiologist Silvio Papapietro, MD, warns that these guidelines should be taken as just that – guidelines. “Guidelines are written to make things simpler, and are based on scientific evidence, but also, to a large extent, on expert opinions,” he says. “Although they’re guidelines, each patient is an individual and should let his or her doctor make a recommendation on aspirin therapy.”

Balancing the Benefits and Risks 
Papapietro says, “For patients who have coronary heart disease, a heart attack or any other manifestation, the evidence that aspirin is useful is very clear, especially for patients with well-established coronary disease.

“For example, men over 45 who have a high risk for heart disease, as well as women who have a high risk for stroke should take aspirin if they have a low risk for gastrointestinal bleeding. The heart benefits need to outweigh the bleeding risks,” he says.

The recommendations, published in the Annals of Internal Medicine, state:

  • Men aged 45 to 79 with heart risk factors should take aspirin if the preventive benefits outweigh the risk of bleeding.
  • At-risk women aged 55 to 79 should take aspirin if the odds of reducing a first ischemic stroke outweigh the chance of bleeding.
  • Men under the age of 45 and women under 55 who have never had a heart attack or stroke should not take aspirin for prevention.
  • At this time, it is not clear whether patients aged 80 and older should take aspirin.

The task force emphasized that the recommendations only apply to people who have never had a heart attack or stroke. The last task force recommendations came out in 2002. At the time, the panel acknowledged that the evidence for the use of aspirin in preventing heart problems was still evolving.

A second paper in the same issue of the journal reaffirms the current task force guidelines. Lower doses of daily aspirin (75 milligrams to 81 milligrams) are equally, if not more effective, than higher doses (100 mg or more) in preventing heart attack and stroke in at-risk individuals.

The paper also found that high doses may actually do more harm, especially in people taking the clot-dissolving drug clopidogrel (Plavix®).

Aspirin is the most used drug worldwide to prevent heart attack and stroke, according to background information in the study. More than one-third of US adults are believed to take aspirin each day.

Papapietro reiterates, however, that patients should always consult their physician before beginning any aspirin therapy.

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