Aspirin usefulness depends on individual risks

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December 24, 2018 - 9:02 AM

Dear Dr. Roach: Like many men, I have been taking 81-mg aspirin for decades. I recently saw a report indicating that not only is it not helpful, but that it actually can increase the risk of internal bleeding and the likelihood of death from cancer. What is your advice on the wisdom of continuing to take the aspirin? — T.M.

Answer: Aspirin has been used for 50 years or more to prevent heart attacks. Several studies in the 1980s and 1990s confirmed that aspirin is effective at preventing the first heart attack in men at average or high risk for heart disease. One trial was so persuasive that it was stopped early, as it was deemed unethical to allow the men on placebo to continue without being offered aspirin. The Women’s Health Study in 2001 showed that aspirin reduces risk of stroke in women. 

However, aspirin has a well-known risk: It can cause bleeding, especially of the stomach and GI tract, but inside the brain as well. In comparing the risks and benefits, the studies showed that between 30 and 200 men need to be treated with aspirin for five years in order to prevent a heart attack, while one man in 100 or so will develop a bleed bad enough to require hospitalization or transfusion. In the Women’s Health Study, about 500 women needed to be treated for 10 years to prevent one stroke, while one woman in 25 developed bleeding. Of course, some bleeding (such as nosebleeds or blood in the urine) does not have the same effect on quality of life as a stroke.

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