Low-dose aspirin linked to bleeding in the skull, report says

Henrietta Strickland
May 16, 2019

US doctors have long advised adults who haven't had a heart attack or stroke but are at high risk for these events to take a daily aspirin pill, an approach known as primary prevention.

For people without heart disease, taking a daily aspirin to prevent heart attacks and strokes may increase the risk of severe brain bleeding to the point where it outweighs any potential benefit, a research review suggests.

The trials enrolled over 134,000 patients.

For people who have already had a heart attack or stroke, the benefit of low-dose aspirin to prevent another major cardiac event is well established, researchers note in JAMA Neurology.

It concluded that for people without symptomatic cardiovascular disease, taking low-dose aspirin was associated with an overall increased risk of intracranial hemorrhage (or bleeding within the skull), with an even higher risk for people of Asian race/ethnicity and people with a low body mass index. Individuals who took a placebo had a 0.46 percent risk of having a bleed on the brain. The difference was equal to an additional two out of every 1,000 people suffering bleeding in the skull.

"Aspirin should be limited to people at the highest risk of cardiovascular disease and a very low risk of bleeding", he said.

'The absolute magnitude of these adverse effects is modest, but clinically relevant, ' said co-author Dr Wen-Yi Huang, a professor of neurology at Chang Gung University College of Medicine.

An artificial model of a human skull and brain. "This new paper also does not question the potentially lifesaving role of aspirin during a suspected heart attack as directed by a doctor", Bayer said. In people who have fatty deposits in their arteries, known as artherosclerotic plaques, the plaques can break off and trigger clotting, obstructing blood flow to the heart or brain. That risk rises as one ages or develops kidney disease, heart disease, diabetes and high blood pressure.

Low-dose aspirin usually provides between 75 to 100 milligrams of the medication a day. Regular strength aspirin typically contains 325 milligrams.

In individuals who have already experienced a heart attack or stroke, a doctor may prescribe low-dose aspirin to prevent another. Even though there's clear evidence aspirin works for this objective, many physicians and patients have been reluctant to follow the recommendations because of the risk of rare but potentially lethal internal bleeding.

The American Heart Association indicates that doctors may recommend aspirin for people with a strong family history of heart disease or if coronary calcium scans reveal substantial plaque buildup in the arteries.

"Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease", said Roger S. Blumenthal, a co-chair of the group that released the guidelines.

Most people, though, should focus on developing better habits.

"Don't smoke, maintain a healthy body weight, exercise two and a half hours weekly, follow a Mediterranean diet with very little, if any, meat, and keep track of your blood pressure, cholesterol, and blood sugar", advises Samaan. "Those are much more important when compared to recommending aspirin". "If they need the statin, take it".

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