[COLUMN] Aspirin: Safe?

MY column titled “Aspirin, the Wonder Drug” came out in 2002 when this common household item was on the spotlight for its new role in staving off heart attack, medically termed Acute Myocardial Infarction (the killer, Acute MI), blood clots, and stroke.

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 know that aspirin was useful in lowering the risk of Acute MI and that taking aspirin immediately when chest pains developed was a prudent measure on the way to the emergency room. Today, these are all “common knowledge,” especially in this wonderful age of the internet and cyberinformation, where Dr. Google is on-call 24/7.

Studies suggest aspirin reduces the recurrence rate for cancers, or even prevent cancer. For decades, this popular 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 in the legs (thrombophlebitis), which could travel to the lungs (pulmonary embolus) and cause death.

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 good uses, much more than the lay public realizes.

How was aspirin discovered?

In 1827, Leroux of France first came upon salicin, an active ingredient in the willow bark, and in 1838, Piria produced salicylic acid from salicin. In 1897 Hoffman, a German chemist, was able to modify salicylic acid into acetyl salicylic acid (aspirin). In 1899, Dreser introduced aspirin (heroin, codeine) into medicine. All three drugs have been in popular use since then, with more than 40 tons (100 million tablets) of aspirin produced annually worldwide, 40 million pounds in the United States alone, about 300 tablets per man, woman and child per year. The enteric-coated form is preferred to minimize gastric irritation. The 81-mg mini-dose coated tablets are the most popular, taken once daily by millions in the U.S.

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. Aspirin also appears to reduce the risk of ovarian cancer by 20% and also lowers the risk for colorectal cancer. 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 the drug produces analgesic/anti-inflammatory effects by inhibiting the production of pain-producing chemicals called prostaglandins.

Are there other 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. 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 work?

Aspirin, as we stated earlier, thins the blood by preventing platelet aggregation. Platelets are blood components that play 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, a 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), 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 also increases the risk for the development of  “age-related” macular degeneration, the major cause of blindness in older adults. Taking aspirin also raises the bleeding risk for 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 U.S. 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.”

Before embarking on aspirin therapy, or on any other regimen, consult your attending physician.

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The main objective of this column is to educate and inspire people live a healthier lifestyle to prevent illnesses and disabilities and achieve a happier and more productive life. Any diagnosis, recommendation or treatment in our article are general medical information and not intended to be applicable or appropriate for anyone. This column is not a substitute for your physician, who knows your condition well and who is your best ally when it comes to your health.

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The opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs and viewpoints of the Asian Journal, its management, editorial board and staff.

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Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, Health Advocate, newspaper columnist, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian foundation in the United States. He was a recipient of the Indiana Sagamore of the Wabash Award in 1995, conferred by then Indiana Governor, later Senator, and then presidential candidate, Evan Bayh. Other Sagamore past awardees include President Harry Truman, President George HW Bush, Muhammad Ali, Astronaut Gus Grissom and other personalities (Wikipedia). Websites: FUN8888.com, Today.SPSAtoday.com, and philipSchua.com; Email: [email protected].


Dr. Philip S. Chua

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.

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