MY column on “Aspirin, the Wonder Drug,” came out in 2002, when this common household item was in the spotlight for some time for its new role in staving off a heart attack, medically termed acute myocardial infarction (the killer, Acute MI). In 1962, a year after I graduated from medical school, my 46-year-old father succumbed to a heart attack, and at that time, the medical community did not even have a clue that aspirin was useful in lowering the risk of Acute MI and that taking aspirin immediately when chest pains developed was a prudent thing to do as one prepared to go to the emergency room. Today, this is all “common knowledge,” especially in this wonderful age of the Internet, where Dr. Google is on-call 24/7.
A study involving 11,000 people in the United Kingdom is underway to find out if aspirin could really reduce the recurrence rate for cancers, or even prevent cancer as suggested by preliminary data. For more than 4 decades, this popular and cheap pill has been used, not only as antipyretic (against fever), analgesic (for pain), and anti-inflammatory (against arthritis), but also to prevent inflammation in the veins in the pelvis and legs (phlebitis) and resultant blood clots (thrombophlebitis) in the legs which could travel to the lungs (pulmonary embolus) and cause death. Here, aspirin acts as a mild blood thinner.
But, since drugs — almost without exceptions — have “natural” side-effects, does aspirin have any?
What is aspirin?
Aspirin (medically known as acetylsalicylic acid) is a common household medication for pain (analgesic), fever (antipyretic), and inflammation (anti-inflammatory). This “simple” and inexpensive drug is so much underrated and practically taken for granted. Aspirin is really a versatile drug, with a lot of uses, much more than the lay public realizes.
How was aspirin discovered?
In 1827, Henri Leroux of France first came upon salicin, an active ingredient in the willow bark, and in 1838, Raffaele Piria produced salicylic acid from salicin. In 1899, Heinrich Dreser introduced acetylsalicylic acid (aspirin) into medicine. This has been in popular use since then, with about 20 tons used annually today in the United States alone. More than 100 million standard aspirin pills are produced every year, globally. The enteric-coated form is preferred to minimize gastric irritation.
How is aspirin versatile?
Besides being used as an analgesic for pain of various causes (headaches, body aches, arthritis, dysmenorrhea, neuralgia,gout, etc), and for febrile states, aspirin is also useful in the treatment of rheumatic disease, and as an anti-platelet (to thin the blood and prevent blood clots) in coronary (heart) artery and in the deep veins in the legs and pelvis, as we stated above. There have also been articles written in the medical literature postulating reduction in the risk of ovarian cancer by 20% and also lowers the risk for colorectal cancer, as reported in the Journal of National Cancer Institute. Many physicians themselves and patients today take low-dose aspirin (baby aspirin or 81 mg.) daily to reduce the chances of getting a heart attack and stroke by its anti-platelet (blood thinning) action by blocking the production of a prostaglandin called thromboxane. It is believed that the drug produces the analgesic/anti-inflammatory effects by inhibiting the production of pain-producing chemicals called prostaglandins.
Are there other known uses for aspirin?
Aspirin has also been used with success in the treatment of children with Bartter’s Syndrome, and also in enhancing the closure of Patent Ductus Arteriosus, an abnormal connection between the aorta (main artery connected to the heart) and the pulmonary artery (to the lungs) in the newborn. If the PDA does not close normally, surgery may be needed to ligate it (close with sutures) before the child starts school.
There are also studies that suggest regular aspirin use increases the chances of conception and a successful pregnancy, among those women who have had dilemma in getting pregnant or having miscarriages or stillbirths.
How does aspirin reduce risk for heart attack and stroke?
Aspirin, as we stated earlier, thins the blood by preventing platelet aggregation. Platelets are blood component that plays a role in blood thickening or clot formation. When they aggregate (clump together) blood thickens and clots form. Clots tend to clog arteries and veins. When arteries to the heart (coronary) get severely blocked by clots, heart attack occurs, and when this clogging happens to the arteries to the brain, stroke happens. As simple as aspirin, this wonder drug plays a very vital role in these conditions, together with a change in lifestyle (no smoking, low carb/cholesterol diet, regular exercises, etc.) to maintain a thinner blood condition.
Is aspirin safe for children?
Pediatricians all over the world have, for almost 5 decades, discontinued prescribing aspirin for children for pain and fever, because aspirin has been implicated in the occurrence of Reye’s Syndrome in children following a viral (upper respiratory or gastrointestinal) infection, which syndrome could be fatal. For fever or pain, physicians now prefer to prescribe acetaminophen (like Tylenol) or Ibuprofen, but for some specific illnesses (like Kawasaki Disease, Juvenile Rheumatoid Arthritis, etc.) aspirin is still being used effectively by Pediatricians.
What are the side-effects of aspirin?
Besides Reye’s Syndrome in children, allergy (especially those with asthma), life-threatening gastrointestinal bleeding, long-term intake of aspirin (for arthritis or any condition, or even for prevention of cardiovascular diseases), have also shown that it increases the risk for the development “age-related” macular degeneration, the major cause of blindness in older adults. Taking aspirin also raises the bleeding risk of those on blood thinners, like warfarin (Coumadin), dabigatran, apixaban, and on food supplements like evening primrose oil and fish oil. Minor side-effects include headache (believe it or not), bruising, nausea, vomiting, tinnitus (ringing in the ear).
In spite of all this, the new guidelines issued by the US Preventive Services Task Force (USPSTF) “recommend daily low-dose aspirin for heart attack and stroke prevention for individuals aged 50-59 who are at high risk for cardiovascular disease.”
“Taking aspirin every day will increase your chance of survival against serious diseases; this is clear-cut, and aspirin is cheap and effective,” says Peter Elwood, professor of epidemiology at the UK’s University of Wales.
Before embarking on an aspirin therapy, consult your attending physician.
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Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: [email protected]
