Heather Swales, M.D., cardiologist [May 24 2013]
Understanding how aspirin works can help explain why someone might benefit from taking it. Aspirin decreases stickiness of a platelet (blood cells responsible for clotting), reducing its ability to form a clot and cause a heart attack or stroke. This also explains why when you take an aspirin you may bruise more easily or notice that small cuts take longer to stop bleeding. Risk of bleeding complications is why taking a daily aspirin may not be recommended for someone.
From a heart-healthy standpoint, there are two main reasons a patient might take a daily aspirin. The first, called primary prevention, is to prevent a heart attack or stroke from occurring in a healthy person. The other reason, called secondary prevention is to decrease recurrence risk of a heart attack or stroke if you already have coronary artery disease or have had a stroke or heart attack.
There does not appear to be any difference in daily maintenance doses of 75 to 150 mg versus 160 to 325 mg; therefore, low dose daily aspirin therapy (81mg) is usually sufficient. Of course, the decision to take an aspirin regularly should always be made with the help of your primary care doctor, cardiologist or other medical provider.
Primary prevention is more complicated and depends partly on your age, sex, your risk of having a bleeding complication from taking aspirin and your risk of developing a heart attack or stroke. Data suggests that by taking aspirin, stroke prevention is the main benefit for women, while in men it is primarily related to heart attack prevention. The Framingham risk score calculator is commonly used to determine one's likelihood of having a heart attack or stroke in the next 10 years. This risk must be weighed against the risk of having a major bleeding complication from taking daily aspirin. The final decision to take a daily aspirin should always be made with your healthcare provider.
Dr. Heather Swales is director of the Women's Heart Wellness Center at The Hospital of Central Connecticut Center. For referrals to HOCC physicians, please contact our free Need-A-Physician referral service by phone at 1-800-321-6244 or online, www.thocc.org.