As­pirin 101

Should you be tak­ing it? If so, when, how much and what kind?

The Star Malaysia - Star2 - - HEALTH -

AS­PIRIN is of­ten hailed as a won­der drug, thanks to its abil­ity to help stave off heart at­tacks and clot-caused strokes. But fewer than half of the peo­ple who could ben­e­fit from a daily low-dose as­pirin take it, while many oth­ers take it when they shouldn’t.

If you don’t have heart dis­ease, but do have high blood pres­sure or other risk fac­tors, don’t au­to­mat­i­cally as­sume daily as­pirin is a good idea.

“A lot of peo­ple who take as­pirin re­ally shouldn’t,” says Dr Christo­pher Can­non, a car­di­ol­o­gist at Brigham and Women’s Hos­pi­tal, and pro­fes­sor of medicine at Har­vard Med­i­cal School.

“Ev­ery­one as­sumes as­pirin is harm­less, but it’s not.” For some, the down­sides of as­pirin – mainly gas­troin­testi­nal bleed­ing – out­weigh its ben­e­fits.

Here’s what you need to know about as­pirin, in­clud­ing de­tails about dosage, for­mu­la­tions and ways to boost as­pirin’s ben­e­fits and lessen its risks.

Who should take as­pirin?

If you’ve had a heart at­tack or an is­chemic stroke (the type caused by a blood clot), tak­ing a low-dose (81mg) as­pirin ev­ery­day is prob­a­bly a wise move. The same is true if you face a high risk of hav­ing a heart at­tack, for ex­am­ple, if you have chest pain (angina) from heart dis­ease, or have had by­pass surgery or an­gio­plasty to treat a nar­rowed heart artery.

As­pirin pre­vents platelets from clump­ing to­gether in your blood and form­ing a clot. Most heart at­tacks hap­pen when a clot blocks blood flow in a ves­sel that feeds the heart, so damp­en­ing the clot-form­ing process low­ers your odds of a block­age.

To es­ti­mate your risk of hav­ing a heart at­tack or stroke over the next 10 years, you can use one of the cal­cu­la­tors listed at www.health.har­vard.edu/147. If your value is 10% or higher, daily low-dose as­pirin may be help­ful. But the de­ci­sion should al­ways be based on a dis­cus­sion with your doc­tor. He or she should con­sider other health con­di­tions you have, med­i­ca­tions you take, and even your weight.

Be­ware of bleed­ing

In ad­di­tion to low­er­ing the blood’s abil­ity to clot, as­pirin also in­hibits help­ful sub­stances that pro­tect the stom­ach’s del­i­cate lin­ing, cre­at­ing a “dou­ble whammy” effect. As a re­sult, stom­ach up­set or bleed­ing in the stom­ach and in­testines can oc­cur.

If you take daily low-dose as­pirin and your stom­ach starts both­er­ing you, call your doc­tor, says Dr Can­non. With mi­nor bleed­ing, a blood test may re­veal a low red blood cell count (anaemia). With more se­ri­ous bleed­ing, your stools turn black and smelly, and in rare cases, you may vomit blood, which re­quires hos­pi­tal­i­sa­tion and a pos­si­ble blood trans­fu­sion.

Tak­ing as­pirin with food may help as do drugs to treat heart­burn, which help pro­tect your stom­ach. These in­clude sim­ple antacids like Tums, acid block­ers like famo­ti­dine (Pep­cid, Fluxid, generic), or pro­ton­pump in­hibitors (PPIs) such as omepra­zole (Prilosec, Zegerid, generic). A pill that com­bines as­pirin and omepra­zole may soon be avail­able.

Daily as­pirin users can also lower their risk of gas­troin­testi­nal bleed­ing by avoid­ing non­s­teroidal anti-in­flam­ma­tory drugs such as

Most of the low-dose as­pirin sold in the United States is en­teric-coated (some­times called safety-coated). The coat­ing al­lows the as­pirin to pass through the stom­ach to the in­tes­tine be­fore fully dis­solv­ing. That is sup­posed to lessen stom­ach up­set, but in re­al­ity as­pirin still af­fects the en­tire di­ges­tive tract via the blood­stream.

“En­teric-coated as­pirin does not de­crease the risk of gas­troin­testi­nal bleed­ing com­pared with un­coated as­pirin,” says di­ges­tive dis­ease ex­pert Dr Loren Laine, a pro­fes­sor of medicine at Yale Univer­sity. The same is true for so-called buffered as­pirin, which com­bines an antacid such as cal­cium car­bon­ate (found in Tums) or alu­minum hy­drox­ide (found in Maalox) with as­pirin.

There’s also ev­i­dence that not all the as­pirin in coated pills gets into your cir­cu­la­tion, which can com­pro­mise its heart ben­e­fits. Your best bet may be chew­able low-dose as­pirin, which you may re­mem­ber from child­hood as or­ange-flavoured “baby” as­pirin. – Har­vard Health Pub­li­ca­tions/McClatchy-Tri­bune In­for­ma­tion Ser­vices

Painful track: as­pirin can cause bleed­ing in the stom­ach and in­testines. (In­set) ev­ery­one as­sumes as­pirin is harm­less, but it is not.

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