Aspirin

You have probably taken aspirin to relieve the pain of a headache or to reduce pain and inflammation in your joints if you have arthritis. However, aspirin, a type of medication called a nonsteroidal anti-inflammatory drug (NSAID), also can be a potent weapon in the prevention of heart attacks in some people. Not only does aspirin relieve pain and inflammation, it's also an antiplatelet drug. It reduces the stickiness of blood platelets, preventing them from clumping together and forming a blood clot that can lead to a heart attack.

Aspirin has long been recommended for secondary prevention of heart attacks—that is, to reduce the risk of repeat heart attacks in people who have already had one. It also may be recommended for the prevention of first heart attacks in men ages 45 to 79 when the risk of a heart attack is greater than the risk of gastrointestinal bleeding (a major side effect of aspirin). However, aspirin is not generally recommended to solely prevent a first heart attack in most people. To find out whether you can benefit from aspirin, have a discussion with your doctor.

In May 2014, the U.S. Food and Drug Administration (FDA) issued a statement cautioning that evidence does not support the general use of aspirin for the primary prevention of heart attack or stroke. That is, the serious risks associated with aspirin therapy outweigh the benefits in people who have not already experienced heart attack or stroke. According to the FDA, the benefits of using aspirin as a secondary prevention measure—in people who have already had a heart attack or stroke—do outweigh the risks. Further research is being conducted.

Aspirin can have serious adverse effects, including gastrointestinal bleeding and, in rare cases, hemorrhagic (bleeding) stroke. Individuals with a history of gastrointestinal bleeding, people with uncontrolled high blood pressure, and those who regularly take other NSAIDs or anticoagulant drugs like warfarin are particularly at risk. Thus, the decision to start aspirin therapy should be made in consultation with your doctor. To protect against gastrointestinal bleeding, your doctor may prescribe a proton pump inhibitor, such as lansoprazole (Prevacid) or omeprazole (Prilosec), along with your daily aspirin. Enteric-coated or buffered versions of aspirin are no less likely to cause bleeding.

According to an article in our sister publication—REMEDY'S Healthy Living Spring 2014, daily aspirin users may want to consider taking an aspirin before bed rather than in the morning. A study by Dutch researchers found that a nighttime dose might be more effective at reducing the risk of heart attack and stroke.

The researchers studied nearly 300 heart disease patients who took 100 mg of aspirin daily. (Low-dose daily aspirin is often recommended for heart attack survivors and those at high risk of heart disease.) Those who took it at bedtime showed a reduced risk for factors that affect blood clotting during the morning hours, when the chance of a deadly heart attack is greatest.

Plavix

People who have already had a heart attack or stroke or who have been diagnosed with peripheral arterial disease may be able to reduce their risk of a future heart attack by taking clopidogrel (Plavix). Like aspirin, Plavix works by keeping platelets in the blood from forming blood clots. Possible side effects of Plavix include gastrointestinal bleeding and hemorrhagic stroke. To protect against gastrointestinal bleeding, your doctor may also prescribe a proton pump inhibitor, but only if you are at high risk for such bleeding.

Effient

This antiplatelet drug was approved by the FDA in 2009 for use with aspirin to prevent the formation of blood clots after angioplasty with stenting. Studies show that prasugrel (Effient) is more effective than Plavix in preventing blood clots. On the other hand, the newer drug is also more likely to cause serious bleeding. Because of this elevated bleeding risk, people who have had a stroke should not take the drug, and those older than age 75 or using other medications that

Updated by Remedy Health Media

Publication Review By: Roger S. Blumenthal, M.D. and Simeon Margolis, M.D., Ph.D.

Published: 10 Mar 2011

Last Modified: 07 May 2014