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    An Aspirin a Day ... or Not?

    Aspirin's protective powers may now guard against cancer, too.

    More Isn't Always Better continued...

    "Low-dose aspirin, a 'baby aspirin' dose of 81 milligrams, is safer and just as effective as the standard adult dose of 325 milligrams," says Dr. Fendrick. "When a drug has serious side effects, as aspirin does, you want to give the lowest effective dose. We know now that you don't need 325 milligrams in a great majority of circumstances."

    A patient who's having a heart attack right now, for example, should be given a full 325-milligram dose of aspirin, but the person at elevated risk for a heart attack, who's taking daily aspirin as a preventive measure, should stick with the smaller 81-milligram dose.

    Taking low-dose aspirin isn't the only way to maximize the drug's benefits while minimizing its dangers. For people at increased risk of gastrointestinal complications, Fendrick recommends combining any aspirin therapy with a prescribed proton pump inhibitor (PPI) such as Prevacid, Prilosec, or Nexium.

    In a study of people with prior gastrointestinal bleeding, whose doctors felt their chance of having a heart attack was high enough to warrant aspirin therapy despite its gastrointestinal risks, a standard dose of Prevacid reduced their risk of further bleeding by about eightfold. Enteric-coated aspirin or buffered aspirin do not appear to have a reduced risk of bleeding or other adverse events in the stomach.

    Unfortunately, unlike aspirin, these gastroprotective drugs cost a bit more than a couple of cents a day. "If there were no added cost to taking a PPI with a daily aspirin, every aspirin user could benefit from an added level of GI protection," says Fendrick. "But given the current cost of these agents, I only currently recommend gastroprotective therapy to those aspirin users who are at increased risk for GI complications."

    That includes people who have had gastrointestinal complications in the past, people who are using high-dose NSAIDs or combining aspirin with other NSAIDs, and people who are taking anticoagulant drugs, among others. "Many older people take aspirin for their heart and then another NSAID for their arthritis," says Fendrick. "This is one of those cases in which two rights make a wrong; the aspirin is good, the NSAID is good, but together they can be dangerous."

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    Reviewed on November 10, 2003

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