Is Aspirin Bad For You?

Aspirin is also known as acetylsalicylic acid (ASA). This popular over the counter drug was originally created from the bark of the willow and birch trees.  Today, mass quantities are manufactured by combining corn starch, water and synthetically produced acetylsalicylic acid.

Aspirin is used for pain, inflammation, fever and addressing cardiovascular issues.  Aspirin’s mechanism of action is two-fold.  Aspirin has the ability to block enzymes in the body know as cyclooxygenase enzymes (COX-1 and COX-2). When you have some type of injury or insult to the body the cyclooxygenase enzymes produce hormones called prostaglandins. These hormones signal the brain to recognize pain and this hormone causes inflammation, swelling and fever.  So it makes sense that when you block COX-1 and COX-2 that you will see a reduction in prostaglandin production and a reduction in inflammation, swelling and fever. 

Aspirin also blocks something called thromboxanes.  These are fatty substances produced by platelets (cells that cause clotting) allowing them to stick together. When platelets stick together it causes a clot.  So it makes sense that if you are at risk for a cardiovascular event, had a cardiovascular event or are in the midst of one you would take aspirin to block the thromboxanes and decrease the clotting in the cardiovascular system.

Before we get to who should be taking aspirin let’s address why aspirin can cause serious GI side effects including ulcerations, perforations (hole in the intestinal tract), and bleeding. Remember that aspirin blocks COX-1 and COX-2.  COX-1 is a main contributor to the health of the lining of our entire intestinal tract.  So if you block COX-1 then you are allowing the GI tract to become susceptible to damage-including bleeding.  And whether you are on a low dose or high dose aspirin the risk is the same. This bleeding can come from the esophagus, stomach, small or large intestine.

GI symptoms to be aware of while on aspirin include:

-Abdominal pain

-Vomiting liquid that looks like coffee grounds (partially digested blood from upper intestine)

-Vomiting bright red blood

-Black “tarry” bowel movements (melena)

-Bright red blood with bowel movement

Melena usually signifies an upper intestinal bleed because by the time the blood is eliminated the enzymes in the upper intestine have partially digested the blood.  It is usually very foul smelling.

The aspirin needs to be discontinued and you need to see a medical professional immediately.

There have also been reports of increase intracranial bleeding (bleeding in the brain) in some individuals on aspirin.  This appears to be from the effect of decreasing platelet aggregation (stickiness of the platelets).

You may have heard of Reye’s Syndrome (rare disease) that can be a fatal disorder that occurs mainly in children (there have been reports in adults) who had an increased risk of Reye’s Syndrome after they experienced some type of viral illness and received aspirin. Parents should never give their children aspirin for a fever until they talk with their healthcare professional.

So who should be taking aspirin? A lot of individuals self-medicate with aspirin because it is over the counter. It is estimated that close to 40% of Americans are taking aspirin on a regular basis.  If you are experiencing pain, fever or inflammation and you reach for the aspirin then alert your health care professional so they are aware and can ask questions to see if you are at risk for GI bleeding.  You should not reach for the aspirin if you are any other NSAIDS (like Motrin/Ibuprofen/Advil etc) or blood thinners because your risk of bleeding more than doubles.  Let your healthcare professional guide you.

As far as cardiovascular disease, health care professionals usually recommend low dose aspirin (baby aspirin-81mg) daily for patients at high risk for a cardiovascular event and for patients that have experienced a cardiovascular event (heart attack, blood clot, stroke etc).  The FDA does not recommend aspirin for low-risk individuals or just as a “general preventative”.  Again, work with your healthcare professional to see if you should be taking aspirin. 

There are some other potential benefits tied to aspirin.  Substantial medical research shows that aspirin decreases the risk of some GI cancers including colon cancer.  Studies also show that there is a decreased risk of prostate, throat and small cell lung cancer in patients on long-term aspirin.  This is due to aspirin affecting different pathways or enzymes outside of cyclooxygenase or thromboxane.  However, recent research is demonstrating that if an individual on long-term aspirin does get cancer it is harder to treat. And it remains to be seen how to predict the risk of someone bleeding on aspirin while taking it to potentially prevent cancer. More research needs to be done and as always your health care professional needs to guide you.