Aspirin Therapy Questioned

A new research analysis published in the Lancet questions traditional recommendations for daily, low-dose aspirin therapy.

Doctors often recommend aspirin as a preventative measure against stroke and heart attack in people who are either at risk or have histories of these conditions. However, according to the meta-analysis, the potential risks of bleeding might outweigh the benefits if the person has not already had a heart attack or stroke.

The researchers analyzed data from six "primary prevention" studies that tested the effects of aspirin in 95,000 people with low-to-average risk factors for heart disease. They also analyzed 16 "secondary prevention" studies, which included 17,000 high-risk patients who already had a heart attack or stroke.

In both the low- and high-risk groups, the risk of non-fatal heart attack decreased by about 20 percent. However, in the lower-risk group, aspirin did not improve the risk of stroke or death from vascular problems. Additionally, aspirin therapy was linked to a statistically significant 33 percent increased risk of internal bleeding. This risk, according to the authors, outweighed the potential benefits.

In contrast, the analysis suggests that the benefits outweighed the risk of serious adverse effects in people who already had a heart attack or stroke. The authors concluded that only people with previous histories of heart attack or stroke should be advised to take a daily aspirin.

The American Heart Association (AHA) recommends that people talk to their doctors before beginning aspirin therapy because the risks and benefits vary for each person.

In a related study, researchers report that injections of nano-silver particles helped prevent blood clots in mice. The silver worked by preventing platelet surface proteins in the blood from clumping together. Unlike other anticoagulants, the nano-silver did not affect other proteins in the blood that help form clots, which may translate into a reduce risk of uncontrolled bleeding. However because this study was done in animals, it is unclear if this therapy would be safe and effective in humans. Additional clinical research is warranted.

For more information about stroke and heart attack, please visit Natural Standard's Medical Conditions database.

Comments

[AVE]

Aspirin has been such a routine part of therapy for many patients, including diabetics; it is surprising to see the conclusion of this study. I wonder what the internal bleeding risks translate to that makes the risks greater than the benefits of stroke and heart attack prevention. Will low-risk patients who have been on aspirin for years now just discontinue taking it?

[JK]

Hmm. I wonder how much more research is needed before the AHA and similar organizations revise their recommendations.

[Sharon A. Burger]

First of all, there are significant health concerns with silver nano particles. I highly doubt that human studies with them will ever take place.

About the aspirin research, I couldn’t agree more with the results found in this study. Aspirin therapy has never had enough evidence to support such widespread use among low-risk patients. The protective effects have almost always been found in high-risk patients; however, Bayer® fails to mention this in its commercials, causing many consumers to self medicate with aspirin in hopes of preventing heart attacks and strokes.

[Joe Kerr]

I don’t understand how a tiny, tiny pill can prevent me from having a stroke, heart attack, or prevent my blood from clotting. Such a tiny pill can’t get to all my parts, right? Is there some places where it can’t reach? How can it make you bleed too much that you die? It’s such a tiny pill!!! How would I prevent those areas from developing clots? If aspirin can prevent blood clots, then why don’t they recommend them when you fly oversees, (because of the pulmonary leg thing).

[Chris Coe]

Really, Sharon? Bayer® is responsible for people self-medicating “in hopes of preventing heart attacks and stroke?” Let’s be reasonable here, most people aren’t taking 81mg of aspirin daily for because a Bayer® commercial told them to. Practice guidelines routinely recommend the addition of aspirin for heart protection in many patients, including JNC-7 recommendations for diabetics. AHA guidelines recommend aspirin in women over 65, regardless of cardiovascular risk. Doctors are prescribing aspirin based on clinical guidelines. I think most patients would rather take fewer medications than more.

[shannon t]

Wow, this is really big news, considering how commonly aspirin is prescribed to seniors and others who may be at risk of cardiac events such as stroke. Both of my parents take aspirin for these reasons every day, and several MDs who I've spoken to recently about stroke for both of them have made sure they are taking aspirin. I am curious about how quickly physicians will a) learn about these findings and b) alter there advice for patients as a result.

[Phil Graves]

Sharon A.,

Well, “Scientists are reporting discovery of a potential new alternative to aspirin, ReoPro…" Their study is scheduled for the June 23rd issue of ACS Nano, a monthly journal. Their research involves particles of silver (1/50,000th the diameter of a human hair) that are injected into the bloodstream.

Nanoparticles can cause some major health concerns, but only if they are used in ways they weren’t intended for. (Ex: If you inhale them, they can actually block alveoli and cause respiratory arrest.) I am assuming that this study will attach ReoPro antibodies to the silver nanoparticles, and the Fab arm will bind to the glycoprotein (GP) IIb/IIIa receptor of human platelets. This will inhibit the platelets from becoming activated, and then the complex would be excreted in urine or feces. Here’s the link to the article: http://www.medicalnewstoday.com/articles/151947.php

[Marvin]

Joe,

Aspirin helps reduce the risk of heart attack and stroke by making platelets, blood cells responsible for clotting, less sticky. This makes them less likely to stick together (resulting in a clot) or to blood vessel walls, making them narrower. A blood vessel becoming blocked in the brain could result in a stroke, and a blockage in an artery supplying blood to the heart could lead to a heart attack. These are due to decreased supplies of oxygenated blood to these organs. So, taking aspirin every day helps reduce the risk of heart attacks and stroke in the long-run.

[merryanne]

The study that was published at the Lancet journal showed that aspirin was associated with a significant reduction in the risk for serious vascular events, but the net effect on stroke events were not significant. In terms of side effects, aspirin was shown to increase the risk for major gastrointestinal bleeding in both men and women and to increase the rate of hemorrhagic strokes in men only. Aside from the trial, there is still insufficient evidence to recommend aspirin in patients >80 years old, but patients and doctors should consider both the benefits and the risks of starting aspirin therapy

[Amiya]

Aspirin has been used for many years now for both primary and secondary prevention of cardiovascular events. It is currently recommended in multiple guidelines, and in order to revise such guidelines, more evidence would need to be presented. For the time-being, like any medication, it is important for clinicians to assess the risks and benefits before blindly prescribing aspirin therapy. In addition, it would interesting to re-assess the role of aspirin in the different populations (separately) that it is typically prescribed to.

[Janice]

I found it very interesting that the silver nano-particles helped prevent blood clots. I wonder if colloidal silver taken by mouth would have a similar effect. I know there can be adverse effects with colloidal silver if taken on a daily basis though. So it probably wouldn't be the best choice for someone in need of long-term therapy.

[Thor]

Yea, there really isn’t too much information supporting long-term use of colloidal silver as safe. In an NS monograph, I came across a case-report of a 71-year-old man who died after four months of colloidal silver ingestion. It may also cause kidney damage, stomach distress, headaches, fatigue and skin irritation. I would agree that I don’t think that it would be a good option for long-term therapy.

[ariel]

The Natural Standard report on the Lancet's recent study is thought provoking. There exists a substantive body of evidence supporting the benefits of low-dose aspirin in secondary prevention of thrombotic stroke and myocardial infarction. However, aspirin's use for primary prevention may be more controversial. The use of low-dose aspirin for primary prevention must be carefully weighed against the potential risks, particularly in those patients who are predisposed to bleeding complications.

[Megan]

Aspirin is commonly recommended on a daily basis for patients at the risk of heart attack and stroke. More specifically, for patients who have hypertension and diabetes, it’s recommended that patients take 81 milligrams of aspirin every day to prevent heart attack and stroke. The primary care provider of my distant relative recommended he takes 81 milligrams of aspirin every day. He is in his mid 30s, and the only reason he is taking aspirin is to prevent heart attack and stroke, after his father and brother recently underwent angioplasties.

[Bob]

The findings in this study were extremely surprising to me, just based on the fact that so many people are recommended to take low dose aspirin to prevent cardiovascular events. However, I think it is hard to definitively conclude that aspirin shouldn’t be recommended in some populations, despite the findings from this study. As the American Heart Association (AHA) recommends, every person is different; and therefore, speaking to a doctor is crucial prior to initiating aspirin therapy. Until more research is done in every specific patient population, I agree with the AHA. Also, I think it is important for doctors to educate patients on signs and symptoms of bleeding as well as carefully monitoring patients after initiating aspirin therapy.

[Crystal]

I am sure that many common therapies may be questioned the same way that aspirin has. Many people are over-medicated and many doctors over-prescribe, abiding by the idea that a pill will help you fix your problems. It is easy to lose sight of treating our bodies well early on since so many drugs are being developed to treat and prevent diseases. Apart from those who are predisposed to certain diseases, we need to focus our efforts on living healthful lives, so that we don’t have to suffer as we age, develop chronic diseases and depend on drugs to help us sustain homeostasis.

[Bob Pantano]

I have read of the many research studies done on colloidal silver, both national and international, at well-respected universities and institutions. My own mother contracted MRSA in the hospital after having knee replacement surgery. She later even had to have a toe amputated due to this MRSA infection she contracted while she was hospitalized. She went home and developed severe open MRSA sores on her legs and was in miserable and painful shape day after day.

After helping her I too became infected and tested postive (as a carrier),for MRSA. I was told, "once you get MRSA, you have it for life," as it is antibiotic resistant, and the one or two that they say do work actually don't completely kill the MRSA bacteria, and it almost always will return sometime down the line.

Upon doing some online research I learned about colloidal silver. After using the oral spray for three weeks, I had my primary care doctor retest me and my results came back negative. After this, I gave it to my mom to use. She used it on her MRSA sores and they cleared up almost immediately. She also used it orally as well. Almost one month later she too was retested and she was negative as well!

From what I've read, the side effects some folks fear are related to the old days when people made their own silver solutions and didn't know how much they were actually using, and it turned their skin blue. But today's products are patented and well within tolerance levels of being safe for humans.

Colloidal silver has been proven to kill over 650 different kinds of bacteria from strep throat to earaches to all staph infections, including MRSA.

But don't take my word for it. Do like I did, and research it online. You'll learn about it like I did, and perhaps you'll have the opportunity to try it out like my mother and I did and see how well it does work. I now swear by it.