Taking Low dose of Aspirin is a Healthy Idea

Written by Dr harold Gunatillake Health writer

It is customary and routine that your doctor will recommend you to take half an aspirin or some blood thinning tablet daily (nocte), after the age of forty five years.

In Sri Lanka the average person is not aware of its importance and awaits a stroke or heart attack to realize its value.

Why should you take it?
In you water soluble blood that runs through your arteries and veins there are cells, nutrients, vitamins, lipoproteins with good and bad cholesterol, among others. These travel through the blood stream, conveying these materials to various sites of tissues, and also supply a good regular oxygen supply for metabolic activities. In the cellular component, there are red cells, white cells and vital platelets. The latter are also called thrombocytes. The platelet count a very important factor, is often ordered as a part of a complete blood count examination.
In an adult, a normal count is about 150,000 to 450,000 platelets per microliter of blood.

If platelet levels fall below 20,000 per microliter, spontaneous bleeding may occur, quite common in dengue and is considered a life-threatening risk. Patients who have a bone marrow disease, such as leukemia or another cancer in the bone marrow, often experience excessive bleeding due to a significantly decreased number of platelets (thrombocytopenia). As the number of cancer cells increases in the bone marrow, normal bone marrow cells are crowded out, resulting in fewer platelet-producing cells.

A normal range of platelets count is required to form a bung at the site of bleeding from a lacerated blood vessel. Platelets are flat rounded coin like structures which tend to adhere together at times of emergencies as described above.

Aspirin taken in any form has a thinning effect on your blood, and the doctors call it anti-platelet activity, meaning they prevent your blood from forming clots that can clog your arteries and cause a heart attack or travel to your brain and trigger a stroke.

A natural product that has the same activity is garlic. Garlic capsules containing dried garlic may not have an anti-platelet activity like the fresh garlic juice. Those people, who carry stents in any blood vessel as in the coronary arteries, and on prescribed medication like clopidogrel and aspirin to maintain a more thinned blood, should avoid eating much fresh garlic.

Do, however, stick with aspirin (if your doc agrees its right for you). The research is clear: Not only can daily aspirin therapy help reduce your risk of heart attack and stroke; it will significantly increase your survival odds if you do have a heart attack. And aspirin does have great additional anti-cancer benefits.

Daily aspirin therapy lowers the risk of heart attack and stroke according to most research papers. There are others who believe that you should be on regular aspirin therapy only if you’ve had a heart attack or stroke, or you have a high risk of either.

Aspirin seems to prevent platelets getting pasted (agglutinate) together, so the chance of clot formation is reduced in narrowed arteries. Clotting can happen within the vessels that supply your heart and brain with blood. If your blood vessels are narrowed due to a process called atherosclerosis with a buildup of fatty deposits called plaque, thinning your blood with aspirin therapy, may help the blood to negotiate through these partially narrowed vessels preventing oxygen starvation of the tissues.

Does aspirin therapy differ in action between the sexes?
For men of all ages, aspirin can prevent a first and second heart attack and also reduce heart disease risk
For women younger than 65, aspirin can prevent a first stroke, prevent a second heart attack and reduce heart disease risk.
For women over 65, aspirin can prevent a first and second heart attack and a first stroke, and reduce heart disease risk.
The risk of bleeding with daily aspirin therapy is about the same in both sexes.
(Information from Mayo Clinic)

Does aspirin reduce the incidence of heart disease?
There are many risk factors for a heart attack, such as:

  • Smoking tobacco
  • High blood pressure — a systolic pressure of 140 millimeters of mercury (mm Hg) or higher or a diastolic pressure of 90 mm Hg or higher
  • Total cholesterol level of 240 milligrams per deciliter (mg/dL) — 6.22 millimoles per liter (mmol/L) — or higher
  • Low-density lipoprotein ("bad") cholesterol level of 130 mg/dL (3.37 mmol/L) or higher
  • Lack of exercise
  • Diabetes
  • Stress
  • Having more than two alcoholic drinks a day for men, one drink a day for women
  • Family history of a stroke or heart attack

If you are in control with the above risk factors, aspirin will reduce your chances of getting a heart attack.

Contraindications
Do not take aspirin daily if you have:

  • A bleeding or clotting disorder (bleeding easily)
  • Asthma
  • Stomach ulcers
  • Heart failure
  • Acid reflux
  • Chronic kidney disease
  • On anti-inflammatory drugs like ibuprofen, Naprosyline, Indomethazine

Diabetes and aspirin benefits for aged over 50 years
Those who suffer from diabetes your doctor will recommend a low-dose aspirin for men over 50 and women older than 60 who have at least have one additional risk factor, such as smoking, family history of heart disease, high cholesterol and high blood pressure.

Normal dose of aspirin is 75 mg (half a Dispirin daily is adequate)
Do not stop taking aspirin suddenly after taking for a long period. You may have a rebound effect that may increase your risk of heart attack or stroke.

If you are undergoing surgery or dental work, your doctor will stop your aspirin therapy for 10 days temporarily

Side effects of daily aspirin therapy

  • Aspirin may over-react and cause a hemorrhagic stroke, on long term therapy
  • The inner lining of the gullet, stomach and beyond may get inflamed and cause ulcerations, leading to gastrointestinal bleeding
  • Occasionally, aspirin can cause an allergic reaction
  • Too much aspirin like quinine in the old days can cause ringing noises in the ears (tinnitus) and eventually hearing loss.

Reacts with alcohol
Avoid drinking alcohol at the time you take your aspirin. Always have your drink before the meal and take your aspirin before retiring to bed.

Aspirin during heart attack?
If you experience angina pain some advice to chew an aspirin for relief in an emergency situation. This may only work if you are on a daily dose of aspirin therapy.
Do not take aspirin if you are having a stroke. All strokes are not due to clots, may even be due to a brain hemorrhage.

 

Liver damage
Aspirin could help prevent liver damage, the latest in a long line of medical benefits claimed for the painkiller.

Breast cancer
Research by the National Cancer Institute in the US last year suggested that women could help protect themselves against forms of breast cancer caused by estrogen by taking low doses of the drug. However the NHS warned that evidence is conflicting and it was inadvisable for women to start taking aspirin on a daily basis in the hope of preventing cancer

Other cancer benefits of aspirin
Aspirin is now proved effective against a range of common cancers. The findings suggest that millions of people could benefit from taking a daily low dose of aspirin, which would also reduce the chances of dying from prostate, lung, esophagus, brain and pancreatic cancers.

"These results do not mean that all adults should immediately start taking aspirin, but they do demonstrate major new benefits that have not previously been factored into guideline recommendations," said Professor Peter Rothwell, of the University of Oxford, who led the research.
Professor Rothwell and his colleagues also say that those who took aspirin for between five and ten years had a 10 per cent lower risk of dying from any cause, including internal bleeding, during that time.

For cancers of the pancreas, esophagus, brain and lungs, it took at least five years of daily aspirin to see a reduction in deaths, ten years for stomach and bowel cancer and 15 years for prostate cancer.
For cancer of the lung and throat, the protective effect was confined to adenocarcinomas, the type typically seen in non-smokers.

"Perhaps the most important finding for the longer term is the proof of principle that cancers can be prevented by simple compounds like aspirin, and that 'chemo-prevention' is therefore a realistic goal," Professor Rothwell said
The mechanism by which aspirin stops cancer developing is unclear, although laboratory research suggests that it may repair damaged DNA or cause potentially dangerous cells to commit suicide.
Aspirin is believed to have a preventive effect because it inhibits an enzyme called COX-2, which promotes cell proliferation in cancer tumors.

Vascular Dementia-Alzheimer’s
The mainstay of management of vascular dementia is the prevention of new strokes. This includes administering antiplatelet drugs and controlling major vascular risk factors. Aspirin has also been found to slow the progression of vascular dementia
However, they do indicate that high doses of aspirin (325mg) over three years benefited people with vascular dementia. There is no direct evidence from clinical trials to tell us whether a lower dose of aspirin would provide the same benefit.  Case note reviews and clinical audit studies do suggest that lower doses of aspirin may also be helpful, but a proper controlled trial is needed.

Before you start taking a low dose of aspirin daily, you should discuss with your family doctor.

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