New Aspirin Guidelines

[eytonxav]

It appears the new guidance is to forego taking a baby aspirin unless you've had a heart attack or stroke. I have type 2 diabetes, high blood pressure and cholesterol that are all well in check. I've been taking 81mg aspirin for decades and am wondering whether to stop, but will not see my PCP for several more months to ask the question. What are others doing?

 

[Alan]

Those guidelines had changed here by the time we moved back in 2017 so on the advice of my GP I stopped taking my baby aspirin. I do have a couple of friends here who have heart issues and their daily medication includes an aspirin and an antacid(?) to counter the potential long term detrimental effects of aspirin.

 

[braumeister]

I've never been able to take it because it subjected me to frequent nosebleeds.

Any doctor I ever asked said not to worry about it because any possible benefit was tiny anyway.

 

[razztazz]

It appears the new guidance is to forego taking a baby aspirin unless you've had a heart attack or stroke. I have type 2 diabetes, high blood pressure and cholesterol that are all well in check. I've been taking 81mg aspirin for decades and am wondering whether to stop, but will not see my PCP for several more months to ask the question. What are others doing?

Did this study/recommendation say why one should stop taking the aspirin? Is it because it was shown to not really affect things or is there some increased danger in taking it that outweighs its heart-attack-avoidance power? I actually heard this mentioned about 10 yrs ago a few times then it sort of went into the memory hole: That taking an aspirin a day without any known heart problems was actually of no value even though the Bayer commercials were saying taking an aspirin a day "can actually prevent one third of all first heart attacks."

It's sort of moot to me as I've already had "the big one" and am talking a St Giuseppe aspirin a day for that, but I did stop taking one a day some years back based on this not-very-oft-spoken of/under-the-radar observation about the aspirin a day theory. I like to keep up with trends of this nature.

 

[pacergal]

we stopped taking it when the guidelines came out.
we do take daily fish oil for heart health and that also helps prevent clotting.

 

[Alan]

The National Institute of Clinical Excellence. (NICE) sets the standards for GPs in the UK and they cite studies to back up their advice. As one might expect it is all very marginal.

https://cks.nice.org.uk/topics/antiplatelet-treatment/management/primary-prevention-of-cvd/

Aspirin use, in general, should be restricted to people with a prior history of cardiovascular disease (CVD) [BIHS, 2017].

Aspirin may be considered beneficial for primary prevention if an individual’s future risk of stroke or heart attack is higher than average.
An accurate quantitative assessment of CVD risk is essential before prescribing aspirin for individuals in the primary prevention of CVD, where the evidence for benefit versus harm is very limited.

Antiplatelet therapy is not recommended in people who do not have CVD, due to the increased risk of major bleeding [ESC, 2016].

In a systematic review of six trials (n = 95,000), which compared the long-term use of aspirin vs control in people without overt CV or cerebrovascular disease, a risk reduction from 0.57% per year to 0.51% per year of serious vascular events was found, and major gastrointestinal (GI) and extracranial bleeds increased by 0.03% per year. The risk of vascular mortality was not changed by treatment with aspirin.

In a Japanese study (n = 14,464), people aged 60–85 years with hypertension, dyslipidaemia or diabetes mellitus were randomized to treatment with 100 mg aspirin or placebo. The 5-year cumulative primary outcome event rate (death from CV causes) was not significantly different between the groups, but treatment with aspirin significantly increased the risk of extracranial haemorrhage requiring transfusion or hospitalization (P = 0.004).
However, in a position paper, an ESC working group suggested that aspirin should be considered in the primary prevention of CVD in people at a high risk of major cardiovascular events — more than 2 per 100 subject-years, provided there is no clear evidence of increased risk of bleeding (GI bleeding or peptic ulcer disease, no concurrent use of other medications that increase bleeding risk) [Halvorsen, 2014].

In the absence of such conditions, people with a 10-year risk of major CV of more than 20% should be given low-dose aspirin, and people with a risk 10–20% should be considered potentially eligible

 

[PatrickA5]

I have an annual checkup with my PCP on Monday. I'll ask then.

I've been taking the baby aspirin for 6 years after I found out I have mild artery disease. The old guideline was to keep taking it if you knew you had CAD. Now, it sounds like for those of us over 60 we should stop taking it unless we've already had a heart attack or stroke.

My DF had several bleeding ulcers over the years and couldn't take aspirin. I wonder if I'm more prone to developing internal bleeding?

 

[eytonxav]

Did this study/recommendation say why one should stop taking the aspirin? Is it because it was shown to not really affect things or is there some increased danger in taking it that outweighs its heart-attack-avoidance power? I actually heard this mentioned about 10 yrs ago a few times then it sort of went into the memory hole: That taking an aspirin a day without any known heart problems was actually of no value even though the Bayer commercials were saying taking an aspirin a day "can actually prevent one third of all first heart attacks."

It's sort of moot to me as I've already had "the big one" and am talking a St Giuseppe aspirin a day for that, but I did stop taking one a day some years back based on this not-very-oft-spoken of/under-the-radar observation about the aspirin a day theory. I like to keep up with trends of this nature.

I just read about it in the local newspaper and have not seen the study, but the new guidelines appear to be still be under review before being made final. The article did say bleeding risks for adults in their 60s and up who haven’t had a heart attack or stroke outweigh any potential benefits from aspirin according to the U.S. Preventive Services Task Force.

 

[Ian S]

It appears the new guidance is to forego taking a baby aspirin unless you've had a heart attack or stroke. I have type 2 diabetes, high blood pressure and cholesterol that are all well in check. I've been taking 81mg aspirin for decades and am wondering whether to stop, but will not see my PCP for several more months to ask the question. What are others doing?

I'm not sure this is totally accurate. Here's what they say https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/aspirin-use-to-prevent-cardiovascular-disease-preventive-medication:

The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults age 60 years or older.

My added bolding. In my case I have been on low dose aspirin for more than 15 years. Over the past few years, I've had several EGD's that have shown no indication of stomach bleeding whatsoever. My parents both had heart attacks and my mother suffered a stroke. My father's second heart attack killed him at age 65. My brother has had a heart valve repaired. My brother and I both have a history of colon polyps. It seems to me my personal situation tilts the balance in favor of continuing a low dose aspirin regimen.

 

[Helen]

My Mom was put on a blood thinner to prevent a stroke. She never smoked, didn't care for alcohol and was never over weight and there was no family history of strokes. In addition, for some reason she was told to take one adult aspirin each day.

She became anemic to the point of fainting and was taken to the ER by ambulance. They admitted her to the hospital and gave her a transfusion; 4 pints of blood and 2 pints of plasma. She had a fatal heart attack while still in the hospital.

She was a patient of two primary care doctors after the doctor prescribed the blood thinner, I don't know why none of her doctors questioned her blood thinner or aspirin.

I feel a lot of guilt for living so far away from her. I should have been more involved.

 

[Alan]

My Mom was put on a blood thinner to prevent a stroke. She never smoked, didn't care for alcohol and was never over weight and there was no family history of strokes. In addition, for some reason she was told to take one adult aspirin each day.

She became anemic to the point of fainting and was taken to the ER by ambulance. They admitted her to the hospital and gave her a transfusion; 4 pints of blood and 2 pints of plasma. She had a fatal heart attack while still in the hospital.

She was a patient of two primary care doctors after the doctor prescribed the blood thinner, I don't know why none of her doctors questioned her blood thinner or aspirin.

I feel a lot of guilt for living so far away from her. I should have been more involved.

Sorry to hear about your Mom. Living a long way from her must have been tough. My wife and I count ourselves fortunate that we both had siblings living very close to our parents in their final years.

 

[ERObjd]

i have been taking 81mg asprin for probably 6-7 years now. My VA doc recommended i do so based on my overall health and family history of heart issues . No issues with taking it so far. i take it along with my high bloo medicine. I am age 61. It is cheap enough to take and I buy it out of pocket even though VA would give it to me free. A bottle of 300 is maybe $3 at most. I plan to keep taking it.. These studies that come out very often tend to flip flop.. eggs are bad, eggs are good, coffee bad, coffee good, whiskey good, whisky bad and on and on. I say all things in moderation and I dont worry about these studies that flip and flop constantly.

 

[VanWinkle]

i have been taking 81mg asprin for probably 6-7 years now. My VA doc recommended i do so based on my overall health and family history of heart issues . No issues with taking it so far. i take it along with my high bloo medicine. I am age 61. It is cheap enough to take and I buy it out of pocket even though VA would give it to me free. A bottle of 300 is maybe $3 at most. I plan to keep taking it.. These studies that come out very often tend to flip flop.. eggs are bad, eggs are good, coffee bad, coffee good, whiskey good, whisky bad and on and on. I say all things in moderation and I dont worry about these studies that flip and flop constantly.

Same here with taking for 6-7 years when primary suggested it and still taking at this time. I also think the studies will change in a few years again. I have a aortic aneurysm and my cardiovascular surgeon indicated to keep taking the 81 mg aspirin.

 

[eytonxav]

I'm not sure this is totally accurate. Here's what they say https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/aspirin-use-to-prevent-cardiovascular-disease-preventive-medication:

My added bolding. In my case I have been on low dose aspirin for more than 15 years. Over the past few years, I've had several EGD's that have shown no indication of stomach bleeding whatsoever. My parents both had heart attacks and my mother suffered a stroke. My father's second heart attack killed him at age 65. My brother has had a heart valve repaired. My brother and I both have a history of colon polyps. It seems to me my personal situation tilts the balance in favor of continuing a low dose aspirin regimen.

Thanks for providing that link, and your interpretation about initiating sounds correct. This is from the draft recommendation:

For the current draft recommendation, the USPSTF has changed the age ranges and grades of its recommendation on aspirin use. The USPSTF recommends that the decision to initiate low-dose aspirin use for the primary prevention of CVD in adults ages 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one, and recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults age 60 years or older. Based on new analyses of the evidence from primary CVD prevention populations,13 longer-term followup data from the Women’s Health Study (WHS) (JE Buring, personal communication, November 23, 2020), and new trial evidence,22 the USPSTF concluded that the evidence is inadequate that low-dose aspirin use reduces CRC incidence or mortality.

It does not seem to address people that have been on a low dose regime for many years.

 

[ivinsfan]

My Mom was put on a blood thinner to prevent a stroke. She never smoked, didn't care for alcohol and was never over weight and there was no family history of strokes. In addition, for some reason she was told to take one adult aspirin each day.

She became anemic to the point of fainting and was taken to the ER by ambulance. They admitted her to the hospital and gave her a transfusion; 4 pints of blood and 2 pints of plasma. She had a fatal heart attack while still in the hospital.

She was a patient of two primary care doctors after the doctor prescribed the blood thinner, I don't know why none of her doctors questioned her blood thinner or aspirin.

I feel a lot of guilt for living so far away from her. I should have been more involved.

This is sad story in many ways. My DH was on blood thinner for almost 5 years between his 2 heart surgeries. IMO they tend to discount the seriousness of BT. DH had persistent afib and thinners are standard of care. During his first surgery he had his atrial appendage removed which drastically lowers the chance of stroke from Afib. He should have gone off the BT at that point but a scan reading lead to the someone saying the removal wasn't complete.



He stayed on warfarin for almost 5 years, monthly checks, INR between 2 and 3.5 and the INR clinic doesn't really care if you hit the top end of the ranges even though it's way more dangerous for bleeding out. His liver numbers would get wonky too.


At the second surgery with the same surgeon he had a complete blowup over the fact hubbys other two cardio docs hadn't discontinued those thinners. At 70 the surgeon said I've never messed up a clip in my life .
And he was right as he visually inspected the clip in the second op.


When we got discharged he told husband , do not take blood thinners, I put that in your chart and if anyone disagrees tell them to call me>


MY DH had 2 cardio docs, a primary doc and the surgeon...IMO only the cutter was actually looking out for his long term benefit.




Sorry this got long but as Helen points out blood thinners are a big deal and doctors sometimes act like they are not.

 

[The Cosmic Avenger]

My doctor took me off it a few years ago once the new studies were out.