WITH BABY ASPIRIN! Why Everyone Should Not be treated

BY DR IKUNNA ONWUANIBE

Aspirin is cheap and accessible. One can buy aspirin in most countries without a prescription. In Nigeria, most people are their own doctors. It is time to debunk the myth that baby Aspirin is good for everyone, especially those with hypertension.

Two weeks ago, I had a consultation with a Nigerian woman on treatment for high blood pressure in my clinic. She showed me her medications for high blood pressure. She was also taking vasopressin AKA baby aspirin.

Many people take baby aspirin, but do not take their blood pressure medicines. Men can be reluctant to take their blood pressure medication because they believe it gives them erectile dysfunction but will take baby aspirin. However, none of these people have considered the side effects of aspirin before commencing the treatment. They have either bought aspirin because they heard that it is good for your heart or have been prescribed baby aspirin by their doctors.

What are the risks associated with taking baby aspirin?

In healthy people (particularly people with raised blood pressure), who have never had a heart attack or stroke, aspirin can confer a small benefit in reducing heart attacks and some strokes, but this comes with a significant increase in the risk bleeding from the stomach and intestines. The bleeding is minor in most cases, but the bleeding can be substantial and life threatening. These major bleeds are more likely in people who already have stomach ulcer, people older 60 years and people who take certain medications. It can also cause severe bleeding in the brain, causing a stroke. People who cannot take aspirin can be offered an alternative drug.

Access to endoscopy to stop any bleed from the stomach and intestine is highly limited in Nigeria, so the people who bleed from aspirin use may be unable to assess to endoscopy in a timely manner. The current recommendation does not support the use of aspirin for everyone. It is only recommended in people with certain heart conditions and in people with certain types of strokes.

What did I offer to my female patient?

My patient’s blood pressure was elevated above the target. The risks and benefits of taking baby aspirin was discussed and she agreed to an adjustment of her blood pressure medication and to stop taking baby aspirin. If there is a group of people who should not take baby aspirin, it is the group with uncontrolled blood pressure because they are more at risk of having a bleed in the brain.

What does baby aspirin do?

People with heart disease, blood vessel disease, and certain types of strokes may be prescribed baby (low dose) aspirin to help prevent blood clots.

The main contents of blood are red cells which carry oxygen, white blood cells to help fight infection, and platelets which helps with blood clotting. Platelets play an important role: platelets stick together to form blood clots in cuts, so limits blood loss.

Baby aspirin prevents platelets in the blood from clumping together within blood vessels, therefore reduces blood clotting and prevents blood vessels from blocking. This is sometimes referred to as blood thinning. People on baby aspirin may notice that when they have a cut, it takes more time for them to stop bleeding. This is because aspirin has stopped the platelets from sticking together to from clots which increases bleeding time.

What are the benefits of taking baby aspirin?

Baby aspirin is recommended for people who already had a heart attack, blocked blood vessels and some types of strokes. Aspirin is used to reduce their risk of getting another heart attack, blocked blood vessel, or stroke. In this group, the advantage of taking daily aspirin outweighs the problems caused by aspirin, so it is vital that they take aspirin.

The decision to use aspirin daily must be made after carefully weighing benefits against risks. The use of daily aspirin may lower the risk of getting a heart attack and stroke. The risk of heart attack and stroke increases with age, but the risk of adverse effects from use of daily aspirin also increases with age.

The bottom line: Baby aspirin is vital for some people, who have had a heart attack, a stroke, or blood vessel disease, as the benefits of taking daily baby aspirin are greater than the bleeding risks, and so its use may add years to their life. The use of baby aspirin is generally not recommended for people who do not have a history of heart attack and stroke, because the risk of bleeding outweighs the benefits of daily aspirin use.

Dr Ikunna Onwuanibe Family Physician at Dennis Ashley Medical Clinic Landmark Towers, Oniru, VI, Lagos @ikupopsicles

Ikunna has over 25 years’ experience in family medicine and holds a master's degree in public health from the London School of Hygiene and Tropical Medicine. Her main interests are in women’s health and preventing longterm illnesses. Dennis Ashley Medical Clinic offers family physician and endoscopy services.