Who should not take aspirin?
While a daily low dose of aspirin is safe for many people, for some people it is not, and some may have a higher risk of stomach irritation than others. For these reasons, everyone should check with his doctor before starting daily aspirin use.
The more aspirin you take, the higher your risk of stomach ulceration or bleeding. That’s why it’s important to be aware of aspirin as an ingredient in combination medicines, so you can accurately assess your daily intake. Other NSAIDs can also cause gastrointestinal bleeding, so if you take other NSAIDs as well as aspirin, your risk of bleeding increases.
Drinking alcohol also raises the risk of stomach irritation and bleeding, so if you have a history of alcoholism or drink more than three servings of alcohol daily, your health-care provider may advise against daily aspirin use.
Your risk of stomach irritation and bleeding is also higher if you have a history of gastroesphageal reflux disease (GERD) or stomach ulcers, take steroids such as prednisone, smoke, or are over 60 years old. You may still be able to take aspirin, but your doctor may advise you to also take a drug called a proton-pump inhibitor to decrease the amount of acid in your stomach.
Aspirin is generally not recommended if you have gout.
Aspirin and other NSAIDs are not recommended if you have kidney disease.
Aspirin should not be taken if you have active liver disease.
Aspirin should not be given to children and teenagers who have a fever because of the associated risk of Reye syndrome (a serious disease). (Daily aspirin therapy is not recommended for anyone under 21 in any case.)
Always check with your health-care provider before using any product that contains aspirin if you are taking a blood thinner (also referred to as an anticoagulant or antiplatelet medicine). Anticoagulants include pills such as warfarin (Coumadin, Jantoven) and injections such as heparin and low-molecular-weight heparins, which include enoxaparin (Lovenox), tinzaparin (Innohep), and dalteparin (Fragmin). Antiplatelet medicines include NSAIDs as well as clopidogrel (Plavix), ticlopidine (Ticlid), dipyridamole (Persantine), and combined dipyridamole and aspirin (Aggrenox).
You should also check with your doctor before using aspirin if you are pregnant or are breast feeding or if you have asthma, kidney problems, or a history of bleeding problems. In addition, let your physician know you are taking aspirin if you are scheduled for any type of medical, dental, or surgical procedure.
Last, if you notice any of the following symptoms, stop taking aspirin and call your doctor right away: severe stomach pain; coughing up blood; vomit that looks like coffee grounds; black, tarry, or bloody stools; skin rash or hives with intense itching; swelling of the face or eyelids; wheezing or trouble breathing; severe dizziness or drowsiness; any type of ringing in your ears.
One piece of the puzzle
If you are currently taking an aspirin a day under your doctor’s orders, don’t stop. It could be preventing a heart attack or stroke.
However, don’t expect aspirin to protect your cardiovascular health single-handedly. It should be only one part of a coordinated effort that includes heart-healthy eating, maintaining a healthy weight, being physically active, keeping your blood glucose controlled, and not smoking. If, in spite of lifestyle measures, you have high blood pressure, high triglycerides, or high LDL cholesterol and low HDL cholesterol, taking appropriate medicines for these conditions will likely be a part of your heart attack and stroke prevention plan, as well.
The recommendations for who should take aspirin to reduce the risk of cardiovascular “events” has not changed; it just seems the evidence to support aspirin use in people who do not have cardiovascular disease is not as strong as once thought. For people who do have cardiovascular disease, aspirin can be beneficial in preventing heart attack.