Aspirin: The old new wonder drug?

October 31, 2011

Mark L. Friedman, MD, FACEP, FACP

A recent article in the Lancet demonstrated a significant reduction in colon cancer from taking aspirin daily. Aspirin has also been shown to prevent heart attacks and strokes in certain groups at risk. So why aren't we all being told to take an aspirin a day by our doctors?

The answer, as with many issues in medicine, is complicated.

First, there are risks to taking aspirin. Its ability to "thin the blood" (it actually prevents platelet aggregation--the first step in the clotting process) comes with risks, and can result in bleeding and even hemmorrhagic stroke. It can also cause stomach ulcers, which in turn can bleed. Aspirin taken during episodes of the flu or chicken pox can cause Reyes Syndrome, with occasionally fatal liver and neurologic complications. Finally, a small number of people have severe allergic sensitivity to aspirin.

Because of the risks, an individual "risk benefit analysis" needs to be performed, preferably by your doctor, before you start an aspirin a day regimen for years. There must be a long-term strategy for this to be an effective preventive measure.

If there are indications for lifelong medication use, why don't we see ads in the media directing us to ask our doctor if aspirin is right for us? Because there is no money in it for the pharmaceutical companies. Aspirin is not patented, and costs less than a penny a pill. Even the fancy formulations (enteric coated, baby aspirin, exotic doseages such as 81 mg) are relatively inexpensive and really no better than the standard 325mg for 1 penny tablet.

In my opinion everyone should be asking their doctor, "Is aspirin right for me?" If you are in a high risk group for colon cancer or heart disease and have no major contraindications, I think it clearly is. As evidence mounts that aspirin may prevent other forms of cancer as well, including cancers of the pancreas, esophagus, and prostate, not to mention its preventive role in heart disease, the time may be right to consider aspirin prophylaxis for people at above average or possibly even average risk.

Whether an aspirin a day is right for you is certainly worth a conversation the next time you see your primary care doctor.

Originally published Oct 31, 2011 1:00:26 PM.