Baby Aspirin Safer for Preventing Heart Attack
Higher-Dose Aspirin Increases Risk of Serious Bleeding, Researchers Say
March 10, 2005 (Orlando, Fla.) - Taking
aspirin is one of the best ways to prevent a heart
attack. But new research shows that baby aspirin is safer.
Victor L. Serebruany, MD, PhD, a medical researcher at HeartDrug Research in
Towson, Md., says, "it's not rocket science -- lower is safer."
Aspirin helps prevent heart attacks by stopping the formation of clots that
block blood flow to the heart. Aspirin is used to prevent a first heart attack
in people with heart disease risk factors, such as diabetes
and high cholesterol. It's also taken to prevent a second heart attack.
But this "blood-thinning" effect sets aspirin therapy up for some
potentially serious side effects.
Serious Bleeding 5 Times More Common
The new study shows that taking more than 100 mg of aspirin a day increases
the risk of bleeding -- from nose bleeds to bleeding in the brain.
For example, Serebruany says serious bleeding -- like bleeding in the brain
or in the stomach -- occurs in just more than 1% of heart disease patients
taking a baby aspirin (80 mg of aspirin). But serious bleeding occurs in 5% of
heart disease patients taking 200 mg or more of aspirin daily.
When all bleeding was considered -- including minor instances, such as
nosebleeds -- 100 to 200 mg of daily aspirin led to bleeding in 11% of
patients. Bleeding occurred in just more than 3% of patients taking a baby
Serebruany says his study does not address how well different doses of
aspirin prevent heart attacks. "I think it is very probable that low-dose
aspirin is as effective as higher doses to prevent second heart
Heart Specialists Disagree on Aspirin Dose
Serebruany says he decided to investigate the relationship between aspirin
dose and bleeding risk because there was a difference of opinion among heart
specialists. "Cardiologists all like aspirin, but they disagree about how
much aspirin should be used."
He analyzed data from 31 published studies that included information from
200,000 heart disease patients. All the patients were on daily aspirin therapy
at doses ranging from 30 mg daily to 1,300 mg daily.
Robert Bonow, MD, who is chief of cardiology at Northwestern University
Feinberg School of Medicine in Chicago, tells WebMD that, "I think it's
fairly clear from these data that low-dose aspirin is probably the best choice
for prevention -- certainly it is the best choice for [preventing first heart
But Bonow, who was not involved in the study, says most cardiologists
"have individual preferences about using aspirin. For example, if you've
just opened some arteries with stents, you might
want to start the patient off on a high dose because stents do increase the
risk of blood clots."
Stents are tiny, flexible coils that are used to prop open blocked arteries,
but stents also increase the risk of blood clots. "I think doctors worry
about this," says Serebruany. "But I still maintain that lower-dose
aspirin is better and most likely just as effective as higher-dose