[thedoc (OP)]

@uncomn asked the Naked Scientists:
   Should we take a small aspirin everyday and if so what size?
What do you think?

[smart]

No. Aspirin has been deemed inefficient in preventing cardiovascular diseases. Worse, it can potentially cause excessive brain bleeding.

http://articles.mercola.com/sites/articles/archive/2014/08/04/daily-aspirin-side-effects.aspx

[evan_au]

Aspirin deactivates platelets, one of the pathways leading to blood clotting; so (as tkadm30 says), it can lead to increased bleeding in the brain (causing a stroke), in ulcers, injuries or surgery.

However, some heart conditions can lead to excess formation of blood clots, which could pass to the brain and also cause a stroke or heart attack.

So it is a tradeoff of risks, and different studies have come out on one side or the other. If you have a known risk of excess blood clot formation, then your doctor can discuss the advantages and disadvantages for your individual case.
See: https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/docs/fs_aa.pdf

If you take aspirin regularly, it can damage the stomach lining and cause ulcers. Aspirin intended for regular use comes in smaller doses (70-100mg) and has a coating that doesn't dissolve until after the aspirin has passed through the stomach. In contrast, normal aspirin for pain relief aims for rapid action, and doesn't have this delayed-action coating.

Naturally, if you were planning surgery, you would need to discuss the fact that you are taking aspirin.

[chris]

Despite the fact that it would probably never make it through a modern drug on the grounds of safety, aspirin nonetheless saves lives and, on that basis, probably counts as one of the most effective drugs ever invented. And certainly, in terms of the cost effectiveness, one of the cheapest too.

The evidence is that if the patient population is risk-stratified, then those at higher risk of heart attack and stroke derive a net benefit from taking 75mg of aspirin per day. There are other additional benefits like cancer reduction and apparently a reduced likelihood of dementia.

We interviewed Peter Rothwell about this is 2011 on the 100th anniversary of aspirin. This is a link:

https://www.thenakedscientists.com/articles/interviews/aspirin-preventative-medicine

[vhfpmr]

However, some heart conditions can lead to excess formation of blood clots, which could pass to the brain and also cause a stroke or heart attack.

Which ones?

[Colin2B]

However, some heart conditions can lead to excess formation of blood clots, which could pass to the brain and also cause a stroke or heart attack.

Which ones?

Atrial fibrillation

[vhfpmr]

However, some heart conditions can lead to excess formation of blood clots, which could pass to the brain and also cause a stroke or heart attack.

Which ones?

Atrial fibrillation

I wondered if evan_au meant AF, but aspirin is no longer recommended for AF as the benefits are minimal, and the bleeding risk is just as high as with Warfarin and other anticoagulants.

[exothermic]

aspirin is no longer recommended for AF as the benefits are minimal, and the bleeding risk is just as high

This would only be true in AF patients at high risk of bleeding -
which is easily determined via the CHA2DS2-VASc score.

[exothermic]

http://articles.mercola.com/sites/articles/archive/2014/08/04/daily-aspirin-side-effects.aspx

Let's at least stick to peer-reviewed literature. The Mercola crap has no place in a science forum.

[smart]

Let's at least stick to peer-reviewed literature. The Mercola crap has no place in a science forum.

Nonsense. The mercola crap is at least referenced by the FDA...

[exothermic]

Let's at least stick to peer-reviewed literature. The Mercola crap has no place in a science forum.

Nonsense. The mercola crap is at least referenced by the FDA.

Dr. Joseph Mercola Ordered to Stop Illegal Claims: https://www.quackwatch.org/11Ind/mercola.html

Joseph Mercola: Alternative health merchant promotes quack cures, funds organic, anti-GMO groups.
https://www.geneticliteracyproject.org/glp-facts/joe-mercola-alternative-health-merchant-promotes-quack-cures-funds-organic-and-anti-gmo-groups/

http://www.alternet.org/personal-health/four-biggest-quacks-plaguing-america-their-bad-claims-about-science
~

[smart]

From Wikipedia this time:

Studies have not found an overall benefit in the general population of healthy people, although it is possible that there are small benefits for those at especially high risk, despite never having had a heart attack or stroke in the past.[39] One study found that among those who have never had a heart attack or stroke, taking aspirin daily for 1 year prevents 1 in 1,667 from having a non-fatal heart attack or stroke, but caused 1 in 3,333 to have a non-fatal bleeding event. However, the study population were at relatively higher risk than those who had never had a heart attack or stroke.[40]

Aspirin appears to offer little benefit to those at lower risk of heart attack or stroke—for instance, those without a history of these events or with pre-existing disease. Some studies recommend aspirin on a case-by-case basis,[41][42] while others have suggested the risks of other events, such as gastrointestinal bleeding, were enough to outweigh any potential benefit, and recommended against using aspirin for primary prevention entirely.[43] Aspirin has also been suggested as a component of a polypill for prevention of cardiovascular disease.[44][45]

See: https://en.wikipedia.org/wiki/Aspirin

[exothermic]

Aspirin has been deemed inefficient in preventing cardiovascular diseases.

Did you read that @ Mercola's website.... or was that from a Dr Oz episode?



Aspirin for the secondary prevention of atherosclerotic cardiovascular disease
Author:Charles H Hennekens, MD, DrPHFreek Verheugt, MD, FACC, FESCChristopher P Cannon, MDGordon M Saperia, MD, FACC
Literature review current through: Mar 2017. | This topic last updated: Feb 07, 2017.

Atherosclerotic cardiovascular disease (CVD), which includes coronary artery disease, cerebrovascular disease, and peripheral artery disease, is the leading the cause of death in the United States (US) and most developed countries and is rapidly becoming the leading cause of death in the world. In 2014, in the US alone, CVD caused more than 900,000 deaths. The totality of evidence from basic research, clinical investigations, observational epidemiologic studies, and randomized trials has provided strong support for the net benefits of aspirin in decreasing the risk of CVD events in a wide range of patients [1].

The following groups of patients with established cardiovascular disease, or at high risk, benefit from aspirin for the prevention of new cardiovascular events:

Patients with acute coronary artery syndromes such as acute myocardial infarction (MI) and unstable angina to prevent recurrent events. Patients with acute occlusive stroke. Patients with stable cardiovascular disease, such as those with stable ischemic heart disease (including those who have undergone revascularization with coronary artery bypass graft surgery), stable peripheral artery disease, or carotid artery disease.


US Pharm. 2017;42(2):27-31.
Management of Coronary Artery Disease and Chronic Stable Angina
Yesenia Camero, PharmD, BCPS
Jinwi Ghogomu, PharmD, BCPS, CPh

Aspirin is an antiplatelet agent that works through irreversible inhibition of cyclooxygenase, leading to decreased formation of the prostaglandin derivative thromboxane A2 and to inhibited platelet aggregation. Aspirin has been associated with a 37% reduction in the risk of serious CVEs, as well as a 46% decrease in the risk of unstable angina and a 53% decrease in the need for coronary angioplasty.7

~

[vhfpmr]

aspirin is no longer recommended for AF as the benefits are minimal, and the bleeding risk is just as high

This would only be true in AF patients at high risk of bleeding -
which is easily determined via the CHA2DS2-VASc score.

The current 2016 guidelines for the management of AF from the European Society of Cardiology state:

"The bleeding risk on aspirin is not different to the bleeding risk on VKA or NOAC therapy, while VKA and NOACs, but not aspirin, effectively prevent strokes in AF patients."

and:

The evidence supporting antiplatelet monotherapy for stroke prevention in AF is very limited. VKA therapy prevents stroke, systemic embolism, myocardial infarction, and vascular death better than single or dual antiplatelet therapy with aspirin and clopidogrel ............Antiplatelet therapy increases bleeding risk, especially dual antiplatelet therapy (2.0% vs. 1.3% with antiplatelet monotherapy; P , 0.001), with bleeding rates that are similar to those on OAC. Thus, antiplatelet therapy cannot be recommended for stroke prevention in AF patients.

The 2012 guidelines said much the same:

"The efficacy of stroke prevention with aspirin is weak, with a potential for harm, since the risk of major bleeding (and ICH) with aspirin is not significantly different to that of OAC, especially in the elderly."

The CHA2DS2-VASc score is for assessing the risk of additional ischaemic strokes due to the AF, the HASBLED score is for assessing the additional risk of haemorrhagic strokes due to anticoagulation. Comparison of the two tells you whether you're better off with or without anticoagulation.

[exothermic]

Thus, antiplatelet therapy cannot be recommended for stroke prevention in AF patients

Your original statement i.e. "aspirin is no longer recommended for AF".... is only partly true --> aspirin is recommended in AF patients with NSTEMI or following angioplasty/stent-placement.

[exothermic]

The CHA2DS2-VASc score is for assessing the risk of additional ischaemic strokes due to the AF, the HASBLED score is for assessing the additional risk of haemorrhagic strokes due to anticoagulation. Comparison of the two tells you whether you're better off with or without anticoagulation.

Thanks for the clarification.

[vhfpmr]

Thus, antiplatelet therapy cannot be recommended for stroke prevention in AF patients

Your original statement i.e. "aspirin is no longer recommended for AF".... is only partly true --> aspirin is recommended in AF patients with NSTEMI or following angioplasty/stent-placement.

So is aspirin deemed better than warfarin (et al) for NSTEMI patients?

[LaurenaS]

The daily dosage of aspirin is not particularly recommended, since it may have a long term effect such as internal bleeding. However, consuming at a recommended dosage does not harm adults in case of pain.