By Kiran Gill
2024 UBC PharmD Candidate
Acetylsalicylic acid, also known as Aspirin®, ASA or Entrophen®, is often used to relieve pain and inflammation. Many individuals also consider taking Aspirin® to prevent potential heart issues. However, questions arise. Is daily Aspirin® the right approach? Should it be taken routinely to prevent heart attacks and strokes? Let’s explore the risks and benefits.
Understanding Aspirin®/ASA
Recent guidance from the Canadian Cardiovascular Society and the Heart and Stroke Foundation recommends against routine Aspirin® use for primary prevention of cardiovascular events if you do not have a previous history of cardiovascular or cerebrovascular disease. (1,2) In other words, if you have not previously had a heart attack or stroke, daily Aspirin® use is not recommended to prevent these events due to the increased risk of bleeding. (2) It is important to note that primary prevention is different from secondary prevention. If you’ve experienced a heart attack or stroke in the past, or have a cardiovascular disease history, that is secondary prevention, which has a different set of recommendations and guidelines. Shared decision making with your healthcare provider is key to determine the role of Aspirin® for your heart health.
What is “Bleeding Risk”?
The blood-thinning action of Aspirin® prevents blood from becoming too sticky and forming clots. While this may sound like a good thing, it can have unintended consequences. Most often, this involves the increased likelihood of bleeding — easy bruising, nosebleeds, stomach bleeds or ulcers, blood in the stool or vomit, or intracranial (brain) bleeding. When it comes to using Aspirin®, it’s all about weighing the risks and benefits to tailor recommendations to your specific needs.
Taking Aspirin® During a Heart Attack
While routine aspirin use for primary prevention is no longer recommended, guidelines from the Heart and Stroke Foundation continue to recommend using Aspirin® if you’re experiencing signs or symptoms of a heart attack. (1) This is due to its ability to prevent the heart attack-causing clot from growing. For prompt action, Aspirin Canada recommends chewing two 81 mg tablets. (3) Chewing the tablets allows for faster absorption into the bloodstream, which is especially crucial if the tablets are enteric-coated. The bottom line: Aspirin® comes in different doses, formulations and flavours (orange-flavoured chewable tablets!) so if you’re experiencing signs of a heart attack, call 9-1-1 and chew two 81 mg tablets.
Key Points
- The role of Aspirin® is multifaceted, serving beyond pain and inflammation relief.
- Daily Aspirin® use without a previous history of heart disease is not recommended and can elevate your risk of bleeding.
- Shared decision making with your healthcare provider is essential to determine what’s best for you.
- During a heart attack, prompt action with two 81 mg tablets remains the recommended strategy.
References
- https://www.heartandstroke.ca/articles/asa-for-prevention-what-you-need-to-know
- Bainey KR, Marquis-Gravel G, Belley-Côté E, Turgeon RD, Ackman ML, Babadagli HE, et al. Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology 2023 focused update of the guidelines for the use of antiplatelet therapy. Canadian Journal of Cardiology. 2023 Oct 28; doi:10.1016/j.cjca.2023.10.013
- https://www.aspirin.ca/en/