Sometimes it seems that people fear they will not reach their maximal life span without the benefit of a baby aspirin every day, but aspirin carries some real risks, which can exceed the presumed benefit in many older people. (I don’t take it; and later I’ll give you an Internet site to consult that will tell you if you are better off taking or not taking this venerable drug.) Because aspirin is available over the counter, people may take it without medical supervision or continue long after the risk of bleeding exceeds the potential benefit.
Platelets are small components of blood that adhere (stick to one another) to form clots under the proper conditions and stop bleeding, a function that is critical to life. When platelets adhere under the “wrong” conditions, they can cause clots that close off a blood vessel. If this vessel supplies a portion of your heart, you have a heart attack; if it supplies a portion of your brain, you have a stroke; if it supplies part of your little toe, you may get a skin ulcer, as well as a sense of relief that it wasn’t your heart or brain. Aspirin impairs the ability of platelets to stick together and reduce, but not entirely prevent, the risk of stroke or heart attack.
Some habits increase platelet adherence: smoking (even one cigarette a day), diabetes, lack of activity, stress. Aspirin may not reliably reverse this increase. Exercise and alcohol use reduce platelet adherence, and the Mediterranean diet reduces platelet counts.
Aspirin use increases the risk of bleeding, so it can increase the risk of hemorrhagic strokes, bleeding from the gastrointestinal tract or bleeding into the skin or deeper soft tissues of the body. When taken with warfarin (Coumadin, Jantoven) or the newer drugs that inhibit platelet clotting, the bleeding risk increases significantly. If one is taking warfarin for atrial fibrillation, a cause of stroke in older patients, aspirin adds no protection unless one has recently received a coronary artery stent.
Since aspirin reduces the recurrence of typical (non-hemorrhagic) strokes and of heart attacks, people who have had this type stroke or a transient ischemic attack (a “TIA,” in which stroke symptoms rapidly resolve), a heart attack or proven cardiac chest pain should definitely take aspirin, usually for the rest of their lives. If they are over age 65, they should also take a medicine to reduce the risk of bleeding from their stomach. Proton pump inhibitors, such as omeprazole (Prilosec), pantoprazole (Protonix) and many others, are the preferred choices.
If you are over 80 and don’t have cardiac or stroke diagnoses, you shouldn’t be using aspirin; the bleeding risk exceeds the benefit. For the rest of you, consult the website: The Aspirin Cardiovascular/Gastrointestinal Risk Calculator. You will need to know your blood pressure, total cholesterol and HDL cholesterol, and whether you had an ulcer or diabetes and if you use non-steroidal pain medicines (anything besides acetaminophen). It really is pretty simple and your grandchildren can probably help you find it. It will tell you if you should be taking aspirin and if you should be taking proton pump inhibitors to protect your stomach.
— Dr. Terrell is and the Medical Director of the South Central Center on Aging in Pine Bluff. He received his medical degree from Indiana University and completed a residency and fellowship at the University of Colorado Health Sciences Center. He is certified by the American Board of Family Practice/Geriatrics.