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Many people take low dose aspirin, usually 81 mg, to prevent cardiovascular complications. Doctors frequently prescribe aspirin after a patient has had a heart attack or after a stent has been placed in a coronary artery. But is it safe to stop this medicine? A new study suggests that stopping aspirin suddenly may have grave consequences (Circulation, online, Sept. 26, 2017).

Stopping Aspirin and Cardiovascular Events:

A large Swedish study used medical records and the national death registry to answer the question whether stopping aspirin can lead to dangerous cardiovascular outcomes. In Sweden, low-dose aspirin is available only by prescription. As a result, the investigators were able to determine who was taking the drug and who stopped.

Between 2005 and 2009, more than 600,000 people over 40 were taking low-dose aspirin. During three years of follow-up, about 15 percent of these people stopped taking their aspirin, and more than 62,000 were hospitalized or died from a heart attack or stroke.

What They Found About Stopping Aspirin:

In analyzing the data, the researchers discovered that people who had quit their low-dose aspirin without a clear medical reason were 37 percent more likely to suffer such an event.

Here’s what the researchers reported:

“In this large nationwide patient cohort, discontinuation of long-term low-dose aspirin was associated with a >30% higher risk of cardiovascular events, corresponding to an additional cardiovascular event observed per year in 1 of every 74 patients who discontinue aspirin. The risk appeared to increase as soon as the patients discontinued aspirin, with no safe interval.”

People who were taking aspirin because of a previous heart attack had a higher rate of heart attack, stroke or death if they stopped. In that situation, as many as 1 in every 36 of these patients suffered a cardiovascular complication.

The Swedish investigators characterized the risk this way:

“Aspirin discontinuation appeared especially perilous among patients with previous cardiovascular disease…”

Stopping Aspirin and Rebound Risk:

The Swedish researchers note that “experimental studies have suggested a rebound effect after aspirin discontinuation…” This may increase the risk for blood clot formation.

They pose an important but unanswered question:

“For patients undergoing planned surgery or other procedures, it is unknown whether treatment gaps >7 days or <24 hours before the procedure are safe. For patients discontinuing aspirin therapy, it is unknown whether or when the rebound effect happens. In addition, for patients with poor adherence, any rebound effects may be in play more or less continuously.”

Their Conclusions About Stopping Aspirin:

What are we to make of this new research? The authors conclude:

“Among long-term users of low-dose aspirin, discontinuation of aspirin in the absence of major surgery or bleeding was associated with a >30% increased risk of cardiovascular events. The risk increased shortly after discontinuation. These findings can help policymakers focus on simple measures to ensure treatment persistence with a cheap medication like aspirin with substantial public health gains.”

Other Research on Stopping Aspirin:

The most recent Swedish research is not the first study to report that stopping aspirin suddenly may increase the risk for a heart attack. Not surprisingly, aspirin, even in low doses, can lead to severe stomach irritation. Sometimes low-dose aspirin can cause bleeding ulcers. In such cases physicians almost always stop the aspirin immediately.

One small study in the journal Clinical Gastroenterology and Hepatology (Jan., 2013) reported:

“In patients with cardiovascular disease, discontinuation of low-dose aspirin therapy after peptic ulcer bleeding increases risk of death and acute cardiovascular events almost 7-fold.”

Needless to say, such results put patients between a rock and a hard place. A bleeding ulcer can turn into a life-threatening event. But suddenly stopping aspirin appears to pose scary cardiovascular complications.

The authors of this research state the dilemma:

“Balancing between the cardioprotective effect of aspirin and the increased risk of rebleeding associated with aspirin use requires a careful clinical tradeoff.”

They go on to conclude:

“in patients with cardiovascular comorbidities who are treated for peptic ulcer bleeding, aspirin therapy should not be discontinued at the time of discharge from hospital.”

What Should Patients Do?

We encourage any patient taking aspirin for its heart protective effects to consult with a knowledgeable specialist before stopping aspirin. Every situation is different, so any recommendation needs to be tailored to each patient’s special needs.

This is especially important prior to surgery. Physicians have been wrestling with the question about stopping aspirin prior to surgical procedures for years. A review in the International Journal of Surgery (online, Nov. 15, 2013) asked the following question:

“…should patients on acetylsalicylic acid (ASA) for secondary prevention stop or continue the medication prior to elective, abdominal surgery.”

After reviewing the available literature these authors conclude:

“…it appears that continuing ASA isn’t associated with excessive bleeding. Further adequately powered trials with well-defined end points are needed to answer this important clinical question.”

The People’s Pharmacy Perspective:

It is sad that more research is needed to answer the critical questions of:

  1. Should aspirin be discontinued, especially in heart patients?
  2. If aspirin should be stopped, what is the best way to do that?
  3. Is there a rebound blood clotting reaction to stopping aspirin?
  4. Is there any way to prevent a heart attack or stroke if aspirin is discontinued?

In the meantime, patients will need to ask their doctors about this controversy. Some surgeons will recommend that aspirin be stopped at least a week before they operate. Others may suggest that a day or two is sufficient. As far as we can tell, there is no one-size-fits-all answer to this quandary. That is why it is critical to have a meaningful conversation about the pros and cons of aspirin before any procedure.

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  1. Lamar C.

    I was told I had to take a aspirin along with all of the other medications given me when I had my by-pass surgery. I had no heart muscle damage but only grafting of the veins and arteries. Now after 22 months I learn that the aspirin can kill me if I stop it or at a minimum have a heart attack or a stroke perhaps. That to me is malpractice when doctors and hospitals do not tell you that the aspirin you take can cause this in the long run. Also, if you keep taking it you may bleed or die.

    I would NEVER have taken the aspirin in the first place if I had known that. There are natural products which do the same thing as aspirin without such terrible side affects. I think we need to sue not only the doctors we use who do this, and the hospitals, but also the Aspirin companies for not telling us this all along, and also the Pharmacists who will not tell you this either. It won’t bring back my situation for the better, but it may prevent other people from dying.

  2. Kenneth

    Gee, maybe physicians shouldn’t recommend a daily drug regimen without knowing whether it’s safe to stop. The same goes for benzos.

  3. Coni

    My husband just had his 3rd annual checkup from having 3 stents placed. He is on Plavix, Coreg and a low dose (81 mg) aspirin. He asked his cardiologist about extended use of Plavix and was told that he could stop the aspirin regiment instead of any adjustments on the Plavix.

    After 5 days he now has pain and tingling in his right thigh and calf with no injury or overworking; might this be a “rebound effect”?

  4. Bob
    Tampa, Florida

    If you are taking aspirin to reduce your clotting factor after having a heart attack and stop suddenly, sure you are more likely to get a heart attack. I don’t see what the aspirin has to do with it though. You are more likely to get the heart attack because you no longer have the protection against clot formation provided by the aspirin. You would likely have gotten that heart attack if you never took the aspirin in the first place! Now if there is a rebound effect after stopping aspirin, like your clotting factor goes way up, that would be different. So does that happen? Does the clotting factor go up if you stop aspirin?

  5. Ritsa

    I’m taking aspirin 75 mg for several years. Is it dangerous to stop it now? I did not have any heart surgery. Its been given to me due to high cholesterol and later for half block carotid.

    • Terry Graedon

      Ritsa, we urge you to talk with your doctor before stopping aspirin. We don’t know if this is a danger.

  6. Peggi H

    Since I’ve begun taking aspirin for clotting, I’m wondering what defines “long-term” in the use of aspirin as that relates to rebound effect.

  7. Glenda
    Winter Haven Fl

    I am taking one aspirin a day to help lower my C-reactive protein along with Vit C, Vit E, and turmeric.
    Any problems with doing this? All the doctor recommends is a satin but my cholesterol is excellent and so is all my blood work.

    How do I get a reply from you on my situation?

  8. John

    If your stomach can’t handle aspirin, try Pycnogenol. It’s a natural supplement made from European Pine Bark. It thins the blood and also works well for curbing hot flashes.

  9. Retired RN

    I take low dose ASA (81mg). When purchasing this product, I have noticed that the price is 3-4 times higher than the regular (325 mg) dose ASA. With a drug that has been used for over 100 years, this kind of price gouging should not happen.

  10. David

    Why are so many people taking low dose aspirin in the first place? I read that in studies showing positive results from aspirin it was the magnesium in buffered aspirin (which were used) that helped cardiovascular conditions. People should take magnesium as most do not get enough in their diet.

  11. ray

    Whoa, a 700% increase! All the more reason to follow your advice from ’99 in ‘PP’s Guide to Home and Herbal Remedies’….under Blood Clotting in the index.

  12. Mary
    Raleigh NC

    This is a true story. In the 1950’s, my grandmother had been taking a “heart pill” from her doctor. The older doctor retired and my Granny went to see the young doctor to get her “heart pill” refilled. The young doctor told her,” Mrs. G , this is nothing but aspirin. There is nothing wrong with your heart ” and he refused to refill her heart pill. Three weeks later she died of a heart attack. That was in the 1950’s before any research had been done on the affects of aspirin and the heart!

  13. Anne Foster A
    Seattle, WA

    I have been taking low dose aspirin for several years now since my heart surgery for hypertrophic caridiomyopathy with an obstruction. I don’t have the arterial plaque condition that many patients have. At 74, I have clear arteries confirmed by angiogram and CT heart scans. I know cholesterol issues are different from clotting but I cannot stand to know the unnecessary ingredients in aspirin besides the main ingredient.

    Why do we have to have carnauba wax and propylene glycol in our aspirin? I asked a compounding pharmacist if she could just formulate pure ACA for me and she said yes. Of course, this would not have a coating to protect my stomach. I have been taking nattokinase concurrently with 81 mg aspirin.

    Wouldn’t this do the same thing if I took only that? My cardiologist says I have a slight risk for stroke because of a remnant of an apical pouch. My mild heart attack was due to atrial fibrillation (one time episode) due the the HCM. That is now corrected. Any comments?

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