The People's Perspective on Medicine

Baby Aspirin for a Heart Attack

Long-standing advice to call the ambulance and then chew a baby aspirin for a heart attack is still good. Most people no longer should take aspirin daily.
Single baby aspirin may be helpful to cardiac health

At the end of the 20th century, or even just a decade ago, aspirin was not a controversial drug. Physicians acknowledged its power to ease pain and lower fever. Many recommended that their patients take a low dose daily to prevent heart disease. Over the last several years, however, research has shown that healthy people may experience more harm than good if they take aspirin for prevention. The question remains, however: should you take baby aspirin for a heart attack? Here’s how one reader phrased it.

Does Baby Aspirin for a Heart Attack Make Sense? 

Q. My doctor told me to stop taking baby aspirin daily to prevent heart disease. Years ago, I heard a recommendation to take aspirin while waiting for the ambulance if you felt you were having a heart attack or stroke. Is that still legitimate advice?

A. Anyone who suspects he or she is having a heart attack should call 911 immediately. Although there is controversy about aspirin as a daily preventive measure, the advice to chew an aspirin tablet while awaiting the ambulance still seems valid (Western Journal of Emergency Medicine, Dec. 2015; Emergency Medicine Journal, Nov. 2015). At that point, with emergency help on the way, the benefit of counteracting a blood clot blocking an artery is far greater than the possibility of dangerous bleeding. Data from two large prospective trials showed that people who took baby aspirin for a heart attack were more likely to survive (European Heart Journal. Acute Cardiovascular Care, Sep. 2016).

Strokes Are Different from Heart Attacks:

Anyone who suspects a stroke, however, should avoid taking aspirin. In such a situation, it could make a bleeding stroke worse. Emergency physicians will determine the type of stroke before deciding on the appropriate treatment. A person who experiences a stroke caused by a blood clot in a blood vessel leading to the brain might be advised afterwards to take low-dose aspirin to prevent a recurrence. The evidence on that is still evolving, however, and the doctor may prescribe something different for secondary stroke prevention.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Colon cancer runs in my family on both sides. I’ve been taking one or two 81 mg. aspirin for many years as a general preventative for strokes, which also run in my family. At 71, I’m wondering what Terry and Joe feel about the research and advisability of aspirin for stroke and colon cancer prevention.

My dad was put on it after his colon cancer surgery in his mid 80’s, still going at 96, happily! My brother and I both had four polyps removed at our last colonoscopy, only one the type that could become cancerous. Our grandma on Mom’s side was diagnosed at an advanced stage of colon cancer at 76, passed on at seventy-eight.

Terry and Joe, what’s the latest thinking on aspirin for prevention of colon cancer? (Ischemic stroke also runs on Mom’s side, she had several).

Aspirin at the dose appropriate for clot prevention does appear to be helpful in preventing colon cancer or curtailing its spread. Here’s a link: https://www.ncbi.nlm.nih.gov/pubmed/27903583
Keep up your colonoscopy schedule and ask your doctor about his/her advice on aspirin.

I have a client who takes baby aspirin daily. Recently, he fell through a hole in the floor of a construction site and the whole entire leg was black and blue from bleeding under the skin, progressively for days. I told him I was concerned that this indicated the baby aspirin was making him vulnerable to fatal internal bleeding if he was in a car accident. He shrugged it off.

I agree with Alan. I want to know the same thing! if you think you’re having a heart attack do you take a full aspirin or baby aspirin? (And why with no water?) Please answer.

I have been on aspirin for 22 years since a heart attack. For some time I took 325 mg and then reduced that to 81 mg based on the new research. Now, at nearly 76 years old, I get bruises on my arms with an 81 mg tablet. My internist cut me back to three 81 mg tablets per week instead of the former 7 per week. Still getting the bruises. My dermatologist told me that he gets them too if he takes a single 81 mg aspirin.

Let’s be precise: Baby aspirin (81 mg) is what we refer to when discussing the risks & benefits of taking daily low-dose aspirin for heart attack prevention. Of course, the decision to take low-dose is undertaken in conjunction with a person’s health care professional.

When referring to taking aspirin in the face of an acute heart attack, the recommended dose is 325 mg, which is the strength of one regular, full dose aspirin tablet. If low-dose is all a person has on hand, the directions are to chew FIVE of them to equal the 325 mg dose.

Chewing is important. The aspirin needs to be absorbed as quickly as possible. The aspirin that many persons have on hand is coated to help prevent adverse effects on the stomach, and that coating slows down absorption.

One more point: Some persons take daily low-dose aspirin for non-cardiovascular reasons. Gastroenterologists often recommend it for certain persons to lessen the risk of colon and esophageal cancer. These are typically folks who have a much higher than normal risk.

It’s hard for me to believe that Aspirin is BAD for you. I have been taking it for decades, and here I am still at 82. My doctor has never mentioned anything to me about NOT taking it. I have even taken half of a large aspirin when I have had a pain problem, without any bad effects, at least that I know of. I don’t know if what I have just stated helped or hurt the case in question.

I take a baby aspirin daily (with food). I have a -fib & and I take the aspirin to keep the platelets from sticking together and pooling in my heart.

One baby aspirin is 81 mg. Your first cited reference mentions 162-325 mg for heart attack (2-4 baby aspirin). I read elsewhere that 325 mg should be chewed and it should not be enteric coated. https://www.health.harvard.edu/heart-health/aspirin-for-heart-attack-chew-or-swallow

New data suggests that a baby aspirin is too low of a dose for all but the smallest individuals. It seems like the recommendation was for two 325 mg aspirin tablets for a two hundred-pound man. In our ED we always gave 3-4 baby aspirin for chest pain patients.

If you have been taking a baby aspirin and your doctor says you can stop, do you just stop or do it gradually?

How about a baby aspirin daily to combat blood clots?

So we should still take baby aspirin if we think we’re having a heart attack? Do we take a regular aspirin or just one baby aspirin? Thanks.

Some years ago I read an article that said to not discontinue daily aspirin use suddenly. They mentioned people were having strokes when they stopped taking aspirin two weeks before a surgery. There could be blood clots form if you stop long-term aspirin use suddenly. Have you heard of this?

I had a “bleeding” stroke three years ago. My cardiologist tells me to take a daily baby aspirin. I am reluctant to do so, as it seems counterintuitive, at best.

In 2014 I had a stent placed in my right main heart artery and was on Plavix (generic brand) and a baby aspirin for three years. Cardio doctor then continued me on aspirin alone. This year I needed stents in left and right Iliac arteries. Again, Plavix and continuing baby aspirin which I am still on. I am worried about being on it and worrying if I were not. What to do?????

I’ve been taking aspirin for years and want to remind folks that studies have shown that people who stop taking aspirin are likely to have adverse effects. See below for a blurb followed by links.

Who knew? Getting off the aspirin you were taking to help prevent cardiovascular problems can give you a heart attack. According to a major study of more than 600,000 adults published in the medical journal Circulation last year, those who stopped taking low-dose aspirin daily were 37 percent more likely to have a heart attack or stroke than those who continued popping their daily pill. For all of the study participants, the risk spiked as soon as patients discontinued aspirin and didn’t lessen over time. And for those with previous cardiovascular disease, the risk of getting off aspirin was described as “perilous.”

From:

http://www.clevelandheartlab.com/blog/dangers-of-stopping-aspirin/

https://www.ncbi.nlm.nih.gov/pubmed/28947478
https://www.ncbi.nlm.nih.gov/pubmed/29600015

https://www.ncbi.nlm.nih.gov/pubmed/22975385

How about taking curcumin which also thins the blood? I have heard that it also has some anti-cancerous benefits as well.

I knew I was having a heart attack: chest pain, jaw pain, pain on across my entire collar bone. I called 911 and was told to chew a regular aspirin. I said I took one and was asked if I chewed and swallowed with no water. No, I swallowed it whole with water. I was asked to chew one and swallow with no water, which I did.

I had understood that if you think you are having a heart attack, you should take a full aspirin: 325 mg. But this article just says to take an aspirin, while the headline says it should be a baby aspirin (81 mg). Which is it?

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