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A major controversy in medicine has to do with the value of aspirin. This inexpensive drug has been available for more than 100 years. It remains a gold-standard pain reliever and fever reducer. No other over-the-counter drug has been proven superior. But questions remain about its potential other benefits. Will aspirin help reduce the risk of a heart attack or stroke? What about its potential anti-cancer activity? Many readers have been confused by recent research reporting questionable benefits. They wonder if they should stop aspirin suddenly.

The Latest Aspirin Research Creates Confusion:

Q. There was an article in my newspaper about some new research on older people in good health showing that taking low dosages of aspirin does not lower their risk of cardiovascular disease, dementia or disability. The aspirin increased the risk of significant bleeding in the digestive tract and brain.

My wife and I have been taking aspirin for years, hoping and believing we were doing good. To date, neither one of us has had any heart issues. Our question is should we continue taking the low dosage or stop immediately?

A. The new research published in The New England Journal of Medicine (Sept. 16, 2018)  found that aspirin did not prevent heart attacks in healthy people over 70 years old. You are right that volunteers taking aspirin were more likely to experience bleeding problems.

Your question seems simple, but the answer is not. You should not discontinue aspirin suddenly without checking with your doctors. Last year, Swedish investigators reported a higher rate of heart attacks and strokes in people who suddenly stopped taking low-dose aspirin (Circulation, Sep. 26, 2017).

When People Stop Aspirin Suddenly:

The Swedish study involved over 600,000 users of low-dose aspirin (75-160 mg). These people were followed for a median of three years.

The authors note:

“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.”

Something that many physicians have not considered when encouraging patients to stop aspirin suddenly is a potential rebound effect. The Swedish researchers point out that sudden aspirin withdrawal might lead to a risk of blood clots. The increased risk of cardiovascular complications occurred “shortly after discontinuation” of aspirin.

A review of the Swedish study and other aspirin research in the Journal of Thoracic Disease (January, 2018) concluded:

“Discontinuing long-term aspirin outside the setting of major surgery or bleeding appears unsafe, and efforts should be made to improve adherence.”

Another Alarming Swedish Study:

Other Swedish researchers studied the consequences of suddenly stopping aspirin after the discovery of a bleeding ulcer. This can be a life-threatening situation and it is not surprising that doctors would want to stop aspirin suddenly in such patients.

In this small study at Karolinska University Hospital in Stockholm, 40% of the patients were told to immediately discontinue their low-dose aspirin (Clinical Gastroenterology and Hepatology, Jan. 2013).

What happened over the following two years was startling:

“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.”

The People’s Pharmacy Perspective:

Obviously the results of this study put physicians and patients in a double bind. People taking aspirin who develop a bleeding ulcer are in imminent danger. It is an emergency situation. Virtually all gastroenterologists in the U.S. would immediately demand that aspirin be stopped. But if people have heart disease and stop aspirin suddenly, they may dramatically increase their risk for a heart attack. What a dilemma!

Aspirin is a double-edged sword. It has benefits but it can also cause ulcers and serious bleeding episodes. For people who are over 70 and healthy, aspirin may represent more of a risk than a benefit. For people who are middle-aged with heart disease, aspirin may represent a net benefit.

People should not stop aspirin suddenly unless a health professional has advised them about the best way to do so. People who are about to undergo major surgery should always get clear instructions about how to phase off aspirin.

As far as we can tell, there have been no studies to determine the best way to taper off aspirin. This is a discussion best had with the prescribing physician. Make sure the physician is aware of the Swedish research! People with heart disease may need to remain on aspirin indefinitely unless told precisely how to discontinue the drug.

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  1. Marti
    Raleigh NC
    Reply

    I slowly took less 81mg aspirin daily but still frequently had lots of red blotches on my left arm. I read that taking Tumeric also thins blood so just quit aspirin all together. I no longer have angry red spots on my left arm if I meerly brush it against something. Think the aspirin folks are behind this?

  2. Brad
    Honduras
    Reply

    I took aspirin for 25 years and stopped for a month. During which I took a long trip (over20 hrs) only stopping for gas. I developed dvt in my leg and am now on thinners which they tell me is for life. I wondered if that was partly the cause

  3. Sandy
    Anacortes, Wa.
    Reply

    I, too, was perscribed baby aspirin in my 70’s. I am 86 now.
    Last year, I began to question why I was taking it… since the professionals were themselves questioning its validity.
    I titrated down to one tab a week. There is no magic in that number…except I felt it could serve as a maintenance dose for arteries and veins.
    At the same time I have lessened doses of Neurontin and Metroprolol by titrating down slowly.
    Unfortunately… I found if I go below a certain dosage I get severe tremors.
    NOT sure whether I need these meds or not but my body signals tell me they are not safe to drop… at least, not yet.
    Trust in doctors are at an all time low, so with more guidance from pharmacists that I do trust like People’s Pharmacy. I’m wending my own way through the maze of medicine and natural methods.
    My remaining challenge, since I’m a diabetic of 13 years… is how to keep off ADA’s recommendations for their interesting menu of meds… including Insulin.
    Dangerous to self perscribe? Oh, I don’t know, I AM 86, lived a good life and am enjoying some freedom from meds for a refreshing change.
    As a last word, I have to say… looking back at my whole life’s experiences with drugs, most of the time the side effects caused as much, or more, discomfort and serious side effects… as the malady for which they were prescribed.
    Agree or disagree… those are my words of wisdom.

  4. Trish
    Iowa
    Reply

    I am 73 and have no heart ‘disease’ issues. (I do have life long SVT and recently AV Block electrical malfunctions for which I now have a pacemaker.) I have been taking 81mg aspirin for 25 years. When I read your article on non-benefits of those of us over 70 with no heart ‘disease’ issues, I began a very gradual withdrawal program: One month of 1/2 81 mg aspirin for 3 days and 1 for four days; next month 1/2 aspirin 4 days and 1 for three days, etc. I am in my 5th month of decreasing aspirin and am confident this very, very gradual weaning off 81 mg aspirin will be safe…

  5. katherine
    South Carolina
    Reply

    what about baby aspirin? Was the research done on adult dose of regular aspirin and baby aspirin?

  6. Bob
    Georgia
    Reply

    I take a low dosage aspirin, and all the comments made about stopping suddenly is alarming to me. I guess I’ll continue taking it for life. I am 89 years old….?

  7. WILLIAM
    Downey, Ca.
    Reply

    I have been taking aspirins for over 20 years. Over the years I have switched to Baby aspirins
    I take the aspirin for my a-fib. From my research it keeps the blood from pooling in my heart & my veins clear. Hopefully it helps with other conditions. I make it a point to NEVER take aspirin on an empty stomach. I try to take it after my evening meal. I am 88 years old & in good health except for the a fib.

  8. Judy
    Pennsylvania
    Reply

    This is another instance where millions of older people are utterly convinced low dose aspirin will save them, like statins, when there is no good evidence the benefits if any outweigh the risks.

  9. Aya
    Silver Spring, MD
    Reply

    My 88 year old mother stopped taking aspirin after bleeding from the stomach. She refused to take it any longer. She lived 4 more years.

  10. james
    Colorado
    Reply

    I think that people who want to stop aspirin should taper off – every other day, every third day, etc. AT THE SAME TIME, they should increase their intake of natural antiplatelet agents such as magnesium and fish oil.

  11. Carla
    NE Ohio
    Reply

    Please address all of the research from around the world showing that aspirin, an anti-inflammatory, prevents many cancers (cancer is an inflammatory disease).

  12. Marilyn
    Nebraska
    Reply

    I’m 80 and have been taking aspirin (325) for 40 years. I started when I got migraine headaches and if I took aspirin when I started to get one, it wouldn’t get as severe. Now I have afib and was told I had to take a blood thinner, but talked to the Cardiologist about remaining on aspirin, and no blood thinner……so far things are good. There’s so much controversary on this subject, but I think if you’ve been taking aspirin for years I would be careful how I discontinued it. Never take it on an empty stomach, that will lower the risk of ulcers. Just my opinion….

  13. Paul R
    NC
    Reply

    To me, the most reasonable approach is to titrate it down, like you must do when switching depression drugs. This should work for the Health 70+ group.

  14. Denise B.
    Reply

    My husband took low dose aspirin per his Dr. for years, as a preventive. Then he went off of it for knee surgery. Within days, he had a very tight chest feeling, and he was put in the hospital immediately and needed a triple bypass before he could go home. Aspirin was masking the symptoms of a 90% blockage of his widow-maker artery. Thank God for his knee surgery. Drs were surprised he survived it.

  15. Kathy
    Virginia
    Reply

    I too have seen the articles about low dose aspirin and elderly patients. This is the first on the issues of sudden stopping and is very timely. I am taking my 94 year old mother in for a physical in two days and was going to raise discontinuing this and one other med. My sister and I had discussed just stopping the aspirin but I will make sure she waits until after the appointment. Thank you for another informative and useful article.

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