Q: I have been taking aspirin for more than ten years, ever since a heart attack when I was 51 years old. I only take 81 miligrams per day, but it seems like I've been taking it forever. Is this going to be a problem for me?
A: Many doctors have commented that aspirin, if it were to come on the market in the present day, would never gain FDA approval as an over-the-counter medication. That's because it has a relatively common side effect and a elatively serious toxicity profile.
You probably already know aspirin's common side effect: it can cause bleeding in the stomach. So-called gastrointestinal bleeding due to aspirin can occur even at the low dose of 81 mg per day, and even if taken with food. GI bleeding with aspirin is more likely when patients take other medications that cause bleeding such as coumadin (warfarin) or plavix (clopidrogel). The increase in the absolute risk of major GI bleeding (potentially life-threatening bleeding) among patients taking aspirin compared to placebo is relatively low: about 0.12%. That translates as follows: for every 833 patients who are treated with aspirin, one will have a major gastrointestinal bleed that they would not otherwise have had. The risk of all GI bleeding (including minor bleeding) is much higher.
The other reason why aspirin would probably not be an over-the-counter medication if developed today is that it is very toxic in overdose, and can lead to a so-called metabolic acidosis, a build up of acid that the body tries to "blow off" as carbon dioxide through the lungs. In an older person this can appear as a rapid rate of breathing without apparent cause. In a young person it can appear as a normal rate of unusually deep breaths. Fever, nausea, vomiting, confusion, and ringing in the ears are also common. If not treated, or if treated late, aspirin toxicity can be fatal. Aspirin is not a good medication to have hanging around in your medicine cabinet when your daughter gets in a fight with her boyfriend and takes half a bottle of whatever is there to make the bad feelings go away.But listen, aspirin is, in many ways, an important medication in the doctor's bag of tricks. Aspirin prevents heart attack in patients with a baseline risk per year of 1.5% in about one out of 44 patients who take if for five years. There is a net mortality benefit taking into account the bleeding side effect for about one out of 77 patients who take it for five years. So if your doctor has determined that your risk of heart attack is high and your risk of bleeding from other causes is low, aspirin is a good choice. Here's the question, though: did your doctor prescribe the aspirin you are taking, or have you taken matters into your own hands? Don't play this kind of high stakes game without knowing the odds.Dr. Barbara Lock is a practicing emergency physician and a founding partner of MedPie.com.
