A recent review has discovered an association between low-dose Aspirin and an increased risk of intracranial bleeding, in individuals with no symptomatic cardiovascular disease.
While Aspirin has long been prescribed as preventive against cardiovascular events, the utility has been called into question, and remains controversial, because the risk of intracranial hemorrhaging with high mortality rates could offset the cardiovascular benefits.
In plainer terms, while low-dose Aspirin may theoretically help decrease the risk of a major heart attack, Aspirin significantly increases the risk of internal bleeds and hence could increase the risk of having a heart attack. They increase the risk of bleeding inside of the brain and its extremely serious complications.
These risks were especially pronounced in individuals with a low body mass index, or with Asian backgrounds, who had no specific history of heart attacks or cardiovascular conditions, for whom Aspirin had been prescribed as a preventative.
Aspirin as a Preventative
Aspirin works by preventing a person’s blood from clotting. Normally, when you bleed, platelets (cells in your blood) build up at the site of a wound and form a plug to stop further bleeding while the wound heals. That’s good. But if a person’s arteries have been narrowed, especially near the heart, from other conditions like atherosclerosis (a buildup of fatty tissues in the arteries) then your platelets can get confused and begin clotting inside the artery itself, blocking blood flow to the heart. This blockage then results in a heart attack.
A daily low-dose Aspirin can help to prevent those clots, thereby avoiding the blockage that would cause such a heart attack.
The research compared and evaluated thirteen clinical trials with a cumulative total of roughly 134,000 patients, none of whom had a history of stroke or heart disease. Of those participants who took the placebo pill (aka, an inert sugar-pill presented to the participants as Aspirin) 0.46% experienced intracranial bleeds. Those patients who really were given low-dose Aspirin during the trial were more likely to experience bleeding events, with a 0.63% incidence rate. Put another way, all other things being equal, an extra two people in every thousand had intracranial bleeding when taking low-dose Aspirin compared to the control group.
Low-dose aspirin is between 75 and 100 milligrams. It’s in this range that the meta-study uncovered Aspirin’s link to skull bleeding.
While Aspirin can have a positive preventative effect on heart attacks, the risks may not outweigh the gains in many cases. Instead, patients at extremely high risk of heart attacks, or atherosclerotic cardiovascular disease can benefit strongly eating a plant-based diet low in sugar, salt, trans-fats, processed food, meditating and exercising regularly, and avoiding tobacco, caffeine, and alcohol. A low-dose Aspirin may only be warranted in certain cases and for a specific interval of time (i.e., one year post-major cardiac event). The meta-analysis opens serious questions about the overall medical validity of Aspirin and other blood-thinners as a safe go-to preventative.
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Huang W, Saver JL, Wu Y, Lin C, Lee M, Ovbiagele B. Frequency of Intracranial Hemorrhage With Low-Dose Aspirin in Individuals Without Symptomatic Cardiovascular Disease: A Systematic Review and Meta-analysis. JAMA Neurol. Published online May 13, 201976(8):906–914. doi:10.1001/jamaneurol.2019.1120
Mayo Clinic. Daily Aspirin Therapy: Understand the Benefits and Risks. Retrieved August 2019 from https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/daily-aspirin-therapy/art-20046797