YOU CAN TAKE IT SAFELY, BUT TALK TO YOUR DOCTOR FIRST

ONE of my patients, who’d been to see me weekly for more than a month since undergoing weight-loss surgery, called me to say he was bedridden with severe food poisoning.

I went to see him within the hour and was alarmed to see how ill he was: sweating, his blood pressure was so low I couldn’t get a reading, and his pulse, which should have been 60 to 100 beats per minute, was 120. It only took me a moment to realise that the diarrhoea he had also started passing — black as tar — was melaena, a sign of bleeding in the intestine.

I asked him about his medication and he told me that he decided to take a dose of aspirin, one tablet of 75mg each day, as it seemed to him that this was a good idea for someone overweight, with high blood pressure and raised cholesterol levels. He was sorting out his obesity — he had undergone the operation — but was now worried about his heart.

Aspirin, even small doses, has the potential to cause a torrential haemorrhage from the lining of the stomach after only one or two doses. This is also a potential risk with other non-steroid anti-inflammatory drugs such as indomethacin and ibuprofen. That’s why when these are prescribed, patients are always warned about the risk of gastric side-effects: commonly indigestion but sometimes worse.

A small daily dose of aspirin is

often prescribed to patients with heart disease or following a stroke in order to prevent dangerous blood clots. But the difference is that such patients are usually warned to watch for signs of this danger, such as indigestion-type pain and black-coloured stools (seek immediate advice for either). Furthermore, people on aspirin tend to be on other medication such as statins and, as a result, will have regular monitoring. This will include blood tests which will pick up any bleeding, as bleeding is not inevitably torrential — it can be drip by drip, over time leading to anaemia. My patient, who was just 47, died following his emergency admission. He was in the operating theatre within an hour of arrival and required more than 20 units of blood for resuscitation, but sadly did not survive.

This is a warning to us to be respectful about all medications that can upset the stomach lining, particularly the humble aspirin.

It is distressing to realise that this man died by his own good intentions, self-treating with a readily available drug which he believed would work in his best interests. I would argue that even if the prescription had been initiated by myself, the same complication could well have occurred, such is the nature of this unpredictable side-effect.

If your doctor is prescribing aspirin, request an occasional blood test to check for anaemia and discuss whether a regular acid suppressant drug such as omeprazole might also be a good idea — for protection — even though the jury is still out on that one.