How Daily Aspirin Use Could Backfire

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Taking daily aspirin to prevent heart disease may backfire, a new study suggests. Researchers found that aspirin and other anti-platelet drugs can cause deadly gastrointestinal bleeds, especially in older adults, unless the medications are prescribed along with proton-pump inhibitors (PPIs), a class of heartburn drugs that have been shown to reduce the risk of bleeding.

Multiple outlets reported that, in the U.K. alone, regular use of aspirin and other anti-platelet drugs may cause up to 20,000 major bleeds and roughly 3,000 deaths each year. Fortunately, however, Fatherly verified that this is not necessarily true. “The numbers are very much estimates—which I explained at the time to reporters at a press conference, but that might have been lost in translation,” Peter Rothwell, coauthor of the study, clarified. “I wouldn’t put too much weight on them.”

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Rothwell and his team followed 3,166 patients in the U.K. who had previously suffered from a stroke or heart attack and were told by a doctor to take daily doses of aspirin or similar anti-platelet drugs. Over the course of a decade, 314 of these patients (nearly 10 percent) wound up in the hospital for bleeding. They also found that the risk increased with age. People age 65 and younger had barely a 0.5 percent risk of major bleeds due to aspirin, but those 85 and older were at a 2.5 percent risk.

The Lancet | Annual rates of bleeding events requiring medical attention.

Although the findings are nerve-wracking, they make sense. Aspirin and other anti-platelet drugs decrease the risk of heart attack and stroke by reducing the blood’s ability to form clots that can block arteries. At the same time, if your blood cannot clot, you’re going to be at higher risk for major bleeds. Still, Rothwell is adamant that the risk of heart attack and stroke is far greater than the risk of bleeding due to anti-platelet drugs—so patients should definitely continue taking their aspirin. “In people under 75 the benefits of taking aspirin for secondary prevention after a heart attack or stroke clearly outweigh the relatively small risk of bleeding,” Rothwell told The Guardian “These people needn’t worry.” Give grandpa back his aspirin.

Dr. Tim Chico of Sheffield University (who was not involved in the study) agrees. “I would strongly recommend that people who are considering taking aspirin to prevent potential future problems such as cancer or heart attack (but who have not had a stroke or heart attack) should discuss this with their doctor,” he told the BBC. Not that we can’t prevent some anti-platelet fallout. Rothwell highlights research suggesting that patients who take PPIs alongside aspirin are less likely to suffer the major bleeds. “The key point is that this risk is substantially preventable by taking PPIs alongside aspirin,” he told The Guardian. 

For others, however, the promise of aspirin without consequences is too optimistic. Dr. Yoon Loke of the University of East Anglia, who has studied the relationship between bleeding and aspirin, thinks it’s an inevitable catch-22. “You can’t have this benefit without at the same time running the risk of bleeding in the gut. It seems likely,” Loke told WebMD. “Therefore, that any dose of aspirin which is effective in preventing strokes will carry the risk of bleeding complications.”

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