Rethinking the Right Thing

Rethinking the Right Thing

What do 43 million Americans do every day? They take an aspirin.

Staggering, isn’t it? That’s approximately the total populations of Florida, Illinois, Virginia, and Arizona combined.

This factoid comes from a recent survey conducted by the U.S. Agency for Healthcare Research and Quality. The agency also reports that most of those daily aspirin doses are taken by patients who want to prevent heart attacks and strokes. Doctors tell them it’s the right thing. Advertisements tell them it’s the right thing. Their friends and family members probably tell them it’s the right thing. Even Reuters Health, in its report on the survey above, flatly states that aspirin therapy is the right thing, calling it “a safe way to reduce the effects of heart disease.”

I’m sure many heart disease patients find those words comforting. Unfortunately, research indicates this right thing is on the wrong track.

Questionable combo

Aspirin is an antiplatelet – it keeps platelets (a type of blood cell) from aggregating into clots. In fact, aspirin is such an effective antiplatelet that a single tablet can increase the tendency to bleed easily for up to one week. That’s fine if all you want to do is thin the blood and let the chips fall where they may. But too much blood thinning can be quite dangerous.

In the August 2007 issue of the Canadian Medical Association Journal, researchers from McGill University Health Centre in Montreal report on their examination of patients suffering from gastrointestinal bleeding.

STUDY PROFILE

• More than 4,000 cases of gastrointestinal bleeding were chosen from a general practice database that contained six years of medical records
  
• Each of the selected patients was an adult with a first time diagnosis of gastrointestinal bleeding
  
• Drug use data from this group was compared to drug use data in more than 40,000 patients without gastrointestinal bleeding
  
• Results showed that when the anticoagulant drugs warfarin and clopidogrel were taken with aspirin, gastrointestinal bleeding was more pronounced – in fact, the rate of bleeding was four to six times higher than in subjects who didn’t combine these drugs

Wonder drug less than wondrous

Aspirin is obviously a widely used drug, as is warfarin (brand names include Coumadin and Jantoven), and clopidogrel (brand name: Plavix). When these prescription blood thinners are prescribed, aspirin use is usually discouraged, but that doesn’t mean that each patient gets the message. Those who don’t may be experiencing much more harm than good.

In a 2004 study, UK researchers at the University of Hull divided 279 subjects from the Warfarin/Aspirin Study in Heart Failure into three groups: one group received 300 mg of aspirin daily, one received a standard daily dose of warfarin, and a third group received placebo. Each of the subjects had experienced either heart attack or stroke, prompted by thrombosis (a blood clot in the heart or a blood vessel).

After an average follow up period of more than two years, researchers found that neither the aspirin nor the warfarin therapies provided any greater protection against death, nonfatal stroke, or nonfatal heart attacks than the placebo. In fact, subjects who received aspirin therapy were nearly twice as likely to suffer a heart attack or stroke compared to those who took warfarin or placebo. Gastrointestinal problems were also elevated in the aspirin group.

So if you’re taking a daily aspirin, should you stop? Not before talking to your doctor first. In a 2003 study that reviewed more than 1,200 cases of coronary episodes, researchers found more than 50 cases of heart attacks or other severe coronary problems less than one week after patients discontinued aspirin use.

Sources:
“Study: 43 Million Americans Take Aspirin Daily” Reuters Health, 8/24/07, reutershealth.com
“Drug-Drug Interactions Between Antithrombotic Medications and the Risk of Gastrointestinal Bleeding” Canadian Medical Association Journal, Vol. 177, No. 4, 8/14/07, cmaj.ca
“The Warfarin/Aspirin Study in Heart Failure (WASH): a Randomized Trial Comparing Antithrombotic Strategies for Patients with Heart Failure” American Heart Journal, Vol. 148, No. 1, July 2004, ncbi.nlm.nih.gov