I have many patients who take daily aspirin merely because they think they should. However, the latest evidence shows that only people who have had a prior cardiovascular event or other known vascular disease achieve an overall benefit. In other words, the risks of daily aspirin may outweigh the potential benefits.
What are the risks? Although minimal, even the baby aspirin dose of 81 mg can increase the risk of bleeding as a result of a trauma. The risk of bleeding increases with higher doses, and other risks such as gastrointestinal distress start to enter the picture. Although people with kidney disease should avoid aspirin, an 81 mg daily dose is safe for kidney function.
What if you have strong risk factors for cardiac disease? First and foremost, anyone with serious risk factors should be evaluated for the presence of hidden cardiovascular disease. Also, most diabetics are at high risk for cardiac disease and would probably benefit from daily aspirin. Other risk factors such as family history and age fall into the category of “the art of medicine.” This is where your physician can guide you.
What is the optimal dose? The optimal dose is between 81 mg and 325 mg. However, most physicians would agree that 81 mg is sufficient.
When should you stop your aspirin? Often, patients are told to stop their aspirin for any surgical procedure. However, many surgeries can be safely performed while on 81 mg of daily aspirin (325 mg can increase the risk of bleeding). In addition, stopping aspirin can cause a rebound effect in which your blood could clot even more easily than had you never been on aspirin. If you have a high risk of cardiovascular disease, this rebound can create a far greater risk than that of bleeding during surgery. Your surgeon and regular physician (or cardiologist) should weigh these risks carefully.
Daily aspirin should not be treated as a supplement. Although a wonder drug, in people with no cardiac history or significant risk factors, the risk of aspirin may very well outweigh the potential preventative benefits. It should be prescribed and managed by your physician.