Low-dose Aspirin May Be Linked to Bleeding in the Skull

It is true that the benefits of low-dose Aspirin, particularly for secondary prevention of heart attacks and ischemic strokes, are well established in the scientific literature, with the prevention of recurrent ischemic events outweighing the risks of hemorrhage (Gorelick &  Weisman, 2005; Baigent et al., 2009).

But the value of Aspirin for primary prevention of symptomatic cardiovascular disease is not well established.

Indeed, it’s been a topic of controversy since the risk of cardiovascular events among event-free individuals is typically lower than that of patients with symptomatic atherosclerotic disease.

Thus, the increased risk of Aspirin-induced bleeding offsets the overall benefit that the drug is supposed to provide. (Capodanno & Angiolillo, 2016; Guirguis-Blake et al., 2016; Lei et al., 2016). 

Additionally, low dose Aspirin is associated with a magnified risk of intracerebral hemorrhage associated with Asian race/ethnicity and populations with a mean body mass index (BMI) less than 25 (i.e. BMI < 25 is usually indicative of better health and lower cardiovascular risk). 

It is not warranted to recommend low-dose Aspirin to the general population since the risk does not outweigh the benefit. 

Study Conclusions 

1. The benefits of low-dose Aspirin for primary prevention of cardiovascular events is not well supported in the scientific literature.  It is actually associated with increased risk of intracranial hemorrhage.
2. This risk is even worse among Asians and those with a BMI less than 25.  
3. The outcomes of intracranial hemorrhage are often catastrophic.
4. Serious caution must be taken with the use of low-dose Aspirin in individuals without symptomatic cardiovascular disease.

The more you know...

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References

Baigent, C., Blackwell, L., Collins, R., Emberson, J., Godwin, J., Peto, R., ... & Patrono, C. (2009). Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials.

Cadilhac, D. A., Dewey, H. M., Vos, T., Carter, R., & Thrift, A. G. (2010). The health loss from ischemic stroke and intracerebral hemorrhage: evidence from the North East Melbourne Stroke Incidence Study (NEMESIS). Health and quality of life outcomes, 8(1), 49.

Capodanno, D., & Angiolillo, D. J. (2016). Aspirin for primary cardiovascular risk prevention and beyond in diabetes mellitus. Circulation, 134(20), 1579-1594.

Gorelick, P. B., & Weisman, S. M. (2005). Risk of hemorrhagic stroke with aspirin use: an update. Stroke, 36(8), 1801-1807.

Guirguis-Blake, J. M., Evans, C. V., Senger, C. A., O'Connor, E. A., & Whitlock, E. P. (2016). Aspirin for the primary prevention of cardiovascular events: a systematic evidence review for the US Preventive Services Task Force. Annals of internal medicine, 164(12), 804-813.

Huang, W. Y., Saver, J. L., Wu, Y. L., Lin, C. J., Lee, M., & Ovbiagele, B. (2019). Frequency of intracranial hemorrhage with low-dose aspirin in individuals without symptomatic cardiovascular disease: a systematic review and meta-analysis. JAMA neurology.

Kim, H. C., Choi, D. P., Ahn, S. V., Nam, C. M., & Suh, I. (2009). Six-year survival and causes of death among stroke patients in Korea. Neuroepidemiology, 32(2), 94.

Klatsky, A. L., Friedman, G. D., Sidney, S., Kipp, H., Kubo, A., & Armstrong, M. A. (2005). Risk of hemorrhagic stroke in Asian American ethnic groups. Neuroepidemiology, 25(1), 26-31.

Lee, H. Y., Hwang, J. S., Jeng, J. S., & Wang, J. D. (2010). Quality-adjusted life expectancy (QALE) and loss of QALE for patients with ischemic stroke and intracerebral hemorrhage: a 13-year follow-up. Stroke, 41(4), 739-744.

Lei, H., Gao, Q., Liu, S. R., & Xu, J. (2016). The benefit and safety of aspirin for primary prevention of ischemic stroke: a meta-analysis of randomized trials. Frontiers in pharmacology, 7, 440.

Author

Dr. Payal Bhandari M.D. Dr. Payal Bhandari M.D. is one of U.S.'s top leading integrative functional medical physicians and the founder of San Francisco' top ranked medical center, SF Advanced Health. Her well-experienced holistic healthcare team collaborates together to deliver whole-person personalized care and combines the best in Western and Eastern medicine. By being an expert of cell function, Dr. Bhandari defines the root cause of illness and is able to subside any disease within weeks to months. She specializes in cancer prevention and reversal, digestive & autoimmune disorders. Dr. Bhandari received her Bachelor of Arts degree in biology in 1997 and Doctor of Medicine degree in 2001 from West Virginia University. She the completed her Family Medicine residency in 2004 from the University of Massachusetts and joined a family medicine practice in 2005 which was eventually nationally recognized as San Francisco’s 1st patient-centered medical home. To learn more, go to www.sfadvancedhealth.com.