Aspirin is not as safe as doctors and advertisers would have you believe

Misuse Only As Directed

I admit: When it comes to acetaminophen I’m a woman on a mission, trying to help spread the word that this not-so-benign drug can be lethal when taken in continuous high doses.

Most recently, in the e-Alert “Soft and Sweet and Trouble” (3/17/08), I told you about an Oklahoma University coed who died after exceeding the recommended dosage of Extra Strength Tylenol for three weeks to relieve toothache pain. Sadly, that’s just how easily it can happen.

But what about other painkillers? For instance aspirin.

An HSI Member named Robert writes: “I cannot believe that you continue to carry the rubbish about acetaminophen. Pharmacologists have been trying to get aspirin off the shelf for decades, one of the most dangerous drugs there is. Acetaminophen on the other hand is described by The Lancet as probably the safest of all drugs which like any other must be used as directed.”

The key phrase in Robert’s e-mail is “used as directed.” I agree that acetaminophen is generally safe when used as directed. But the same cannot be said of aspirin – a drug that’s commonly recommended for daily use, and is more dangerous than most people realize.

That one little problem

Aspirin is the drug that got the ball rolling on the 20th Century pharmaceutical boom in 1900 when Germany’s Friedrich Bayer Corporation manufactured the first aspirin tablets.

Ninety years later, research from Harvard Medical School concluded that men who take aspirin on a regular basis reduce the risk of a first heart attack. And the medical mainstream never looked back – low dose aspirin became one of the most commonly recommended drugs for heart health.

Just one little problem: Aspirin prompts internal bleeding.

In a large Australian study that was reported in the British Medical Journal last year, researchers found that elderly subjects with no history of heart disease who used low-dose aspirin therapy reduced their risk of heart attack and ischemic stroke. At what cost? A significant number of subjects had a sharply increased risk of bleeding in the brain or the gastrointestinal tract.

But this was by no means the first indication that aspirin is not as benign as doctors would have us believe.

Don’t mix it up

The 1990 Harvard study suggested an aspirin benefit for men. So what about women?

In a 2005 study that appeared in the New England Journal of Medicine, researchers at the Brigham and Women’s Hospital recruited more than 39,000 healthy women over the age of 45 with no cardiovascular problems. For 10 years, half the group took 100 mg of aspirin every other day and half the group took a placebo. Results showed that aspirin provided no protection from heart attack, although those in the aspirin group had a slightly reduced risk of ischemic stroke.

The downside: Women in the aspirin group were found to have a 40 percent increased risk of gastrointestinal bleeding severe enough to require transfusions.

All non-steroidal anti-inflammatory drugs – which includes aspirin and ibuprofen – have been shown to contribute to GI conditions such as bleeding and ulcers, as well as kidney impairment and increased risk of hypertension in women.

And when acetaminophen is added, risk increases. In the e-Alert “Hidden Risks of Over-the-Counter Painkillers” (12/21/02), I told you about a study that showed how regular use of acetaminophen and aspirin together more than doubles the risk of serious organ damage.

Stop and go

Here’s a detail patients rarely hear from their doctors: Once you’ve started aspirin therapy, stopping it abruptly might actually be dangerous.

A 2003 French study suggests that angina and heart attacks might be prompted by the sudden halt of daily aspirin use. In reviewing more than 1,200 cases of coronary episodes, researchers found a significant number of patients suffered heart attacks or other severe coronary problems less than one week after they stopped using aspirin. Subjects with a history of heart disease were at particularly high risk.

The French team told Reuters news service that doctors should not advise their coronary patients to stop using aspirin, and even stated that aspirin therapy “cannot be safely stopped in any case.”

Tell your family, your friends – everyone you care about: Aspirin, acetaminophen, and other “safe and effective” painkillers are safe ONLY when used with the greatest care.

Sources:
“Epidemiological Modelling of Routine Use of Low Dose Aspirin for the Primary Prevention of Coronary Heart Disease and Stroke in Those Aged 70 or Greater” British Medical Journal, published online 5/20/05, bmj.bmjjournals.com
“A Randomized Trial of Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease in Women” The New England Journal of Medicine, published online 3/7/05, content.nejm.org
“Halting Aspirin Suddenly can Cause Heart Attack” Reuters, 10/29/03, reuters.com