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Should you take a daily asprin?

Aspirin is one of the world’s most well-known and widely taken drugs – you pop it for pain, fever and inflammation.

But it’s also a useful blood-thinning medicine, regularly prescribed to those who’ve had heart attacks, strokes or chest pain (angina) – or to anyone who may be at high risk of those conditions.

Studies have also shown that a daily low dose could have a role in reducing the risk of several cancers, including colon, ovarian and liver cancer. Which is why you may have heard someone recite the words, “an aspirin a day keeps the doctor away”.

A catchy mantra – but is it true? New research suggests that taking regular aspirin without prescription may in fact do more harm than good. A large study from King’s College London has found that for middle-aged and older people currently in good health, the benefits of regularly taking the drug aren’t worth the risk of its common side effect of serious bleeding.

“The message for healthy patients is that taking aspirin has a small benefit to prevent heart disease but also at least as large a harm in terms of serious bleeding,” says Professor Stephen Evans, from the London School of Hygiene & Tropical Medicine.

“For some individual patients, the balance may tip more clearly in either direction.”

Should you take a daily aspirin?

According to GP Dr Andrew Thornber, a safety-first approach is best.

“Many people take it upon themselves to take an aspirin a day to prevent heart attack and cardiovascular issues,” he explains. “But patients should speak to their GP first to decide whether doing so is suitable for their medical needs and if it outweighs the potential risks.”

Daily low-dose aspirin – a dose of 75mg, sometimes known as junior or baby aspirin because it’s smaller than you can find in many pharmacies (although it’s not suitable for under-16s) – makes the blood less sticky, Dr Thornber says, which helps to prevent heart attacks and stroke. But, it isn’t safe for everyone, he warns.

Pharmacist Abbas Kanani agrees.

“I most certainly wouldn’t recommend it as a precautionary measure. Aspirin taken by those with cardiovascular disease can prevent a stroke or a heart attack by around 10 per cent, but the risk of having a bleed increases by around 40 per cent,” Kanani says.

“If you have been prescribed aspirin to prevent a cardiovascular event, then it’s a clinical decision that has been based upon guidelines, evidence and research.

“People who take aspirin as an ‘insurance’ measure will not experience any health benefits, as aspirin works to prevent heart attacks and strokes in those with cardiovascular disease.”

He says it may not be worth the risk: “Instead, you’re putting yourself at risk of a major internal bleed, not to mention complications that may arise should you be involved in an accident or collision that causes a bleed. It will be harder to stop a bleed in those taking blood thinners such as aspirin, which could ultimately put your life at risk.”

When and how is it safe?

“Aspirin is effective in treating headaches, period pain and general body aches associated with the cold or flu,” Kanani says. But, he adds, there are many for whom aspirin is not suitable, such as children under 16, people with asthma, stomach ulcers, kidney problems or bleeding disorders, or women who are pregnant or breastfeeding.

Kanani says he’s concerned that some members of the public treat aspirin too lightly. “As a pharmacist, I see a number of individuals purchasing aspirin on a regular basis.

It’s seen as harmless and there isn’t enough being done to educate the public regarding its potential dangers.

Many GPs are actually unaware that a patient may be taking aspirin.”

Kanani warns that gastric bleeds aren’t the only issue with aspirin and that it’s possible to overdose on the drug. “You can overdose on aspirin if you take large amounts that your kidney is unable to clear,” he says.

This can cause symptoms such as tremors, nausea and vomiting, hallucinations, drowsiness and ringing in the ears. It can even kill you.”

He adds: “If you do take too much, you should seek medical attention as soon as possible.

“Depending on your body weight, kidney function and how much aspirin is in your system [measured by blood or urine samples], your doctor will make the decision either to allow your body to remove the aspirin naturally while monitoring you, or you may be prescribed activated charcoal to reduce the rate at which aspirin is absorbed in the body.

“In life-threatening situations, you may need kidney dialysis or to have your stomach pumped.”

Are other painkillers better?

Of course, there are alternatives to aspirin, such as paracetamol and ibuprofen. “These are much more effective and can be taken together,” says Kanani, adding, “but aspirin is an older-generation pain relief and I find that a lot of elderly patients are insistent on using aspirin because that’s what they’re used to.”

So, if you do prefer aspirin over paracetamol and ibuprofen, should you be taking dissolvables or tablets for swallowing, and is there a difference?

“In terms of clinical effectiveness, they are both the same,” Kanani says.

“Some people find that they have an irritated stomach with soluble aspirin and prefer taking a coated tablet in order to protect their stomach.

“Those looking for pain relief as soon as possible would probably benefit more from the soluble tablet as it is absorbed quicker into the bloodstream, therefore can work faster.”

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