Aspirin for coronary artery disease

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When aspirin is chewed, it works quickly (within 15 minutes) to prevent the formation of blood clots. This decreases the chance that a blood clot will form and block a narrowed heart artery, leading to a heart attack.

Brand-name aspirin is no more effective than generic or store brands.

It has been well documented that aspirin reduces the risk of heart attack in people with known coronary artery disease (CAD). It is also now understood that aspirin lowers the risk of having symptoms for people who have a higher risk for the disease. People who are at high risk for coronary artery disease or who already have coronary artery disease benefit the most from aspirin therapy.

You can take aspirin to help you during a heart attack. After you call 911 or other emergency services, chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin if you are not allergic to aspirin and if there is no other reason that you can't take aspirin. Aspirin slows blood clotting, so a blood clot that is causing the heart attack stays smaller.

You may also take low-dose aspirin (81 mg) every day to help lower the risk of a heart attack or stroke. Low-dose aspirin may be used:

• After a heart attack, to prevent another one.
• By people who have coronary artery disease.
• By people with stable angina.
• By people with unstable angina.
• After bypass surgery or angioplasty.
• By people who have had a stroke or transient ischemic attack (TIA).
• After surgery to prevent a stroke (carotid endarterectomy).
• By healthy men over age 45 when the benefits of aspirin to prevent a heart attack are greater than the risk of stomach bleeding from taking daily aspirin.
• By healthy women over age 55 when the benefits of aspirin to prevent a stroke are greater than the risk of stomach bleeding from taking daily aspirin.

If you have atrial fibrillation and cannot take or choose not to take warfarin, you may take an adult-strength aspirin (325 mg) every day to help lower the risk of a stroke.

Aspirin and coronary artery disease (CAD)

People who are at high risk for coronary artery disease or who have established coronary artery disease benefit the most from aspirin therapy. If you are at risk for heart disease, daily aspirin may lower your risk of heart disease with symptoms like angina. But if you are at low risk for a heart attack or stroke, daily aspirin may have more risks than benefits for you.

People who have established CAD also appear to benefit from aspirin therapy. One large study has shown that people aged 65 and older with both heart failure and coronary artery disease had a significantly lower death rate when they took aspirin on a regular basis.¹

Aspirin and heart attacks

• Aspirin reduces the risk of death and heart attack in people with unstable angina.²
• Aspirin decreases the risk of first heart attack, death from heart attack, and recurrent heart attacks.³
• Aspirin may help reduce the severity of a heart attack when it is chewed and taken immediately after symptoms begin.

Side effects of aspirin include:

• Inflammation of the stomach (gastritis).
• Gastrointestinal bleeding.
• Allergic reaction.
• Increased bruising and bleeding (hemorrhage) in the brain (rare) or other internal organs of the body.

If you have other conditions or risk factors that increase your risk of stroke or bleeding, you may not be a good candidate for aspirin therapy. The risk of bleeding is greater for people with uncontrolled high blood pressure who already take antiplatelet medications, anticoagulants (blood thinners), or anti-inflammatory medications.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Aspirin may be combined with heparin and possibly newer antiplatelet drugs such as abciximab (ReoPro), eptifibatide (Integrilin), and clopidogrel (Plavix) before and after angioplasty to treat unstable angina.

Some doctors believe that people who have two or more risk factors for coronary artery disease should take aspirin every day. Others are concerned that long-term daily aspirin use will increase the risk of stomach problems or stroke when untreated high blood pressure is present.

Any over-the-counter aspirin product will work. No single brand works better than another for preventing coronary artery disease or heart attacks.

The best dose of aspirin has not been established; however, a low dose seems to be as effective in preventing heart attack as higher doses. One low-dose aspirin contains 81 mg; one regular-strength aspirin contains about 325 mg.Consult your doctor before using aspirin on a regular basis.

Because of its effect on blood clotting, your doctor may want you to stop your aspirin at least 5 days before surgery or before a dental procedure that may cause excessive bleeding.

Even though nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, relieve pain and inflammation much like aspirin does, do not substitute NSAIDs for aspirin because they will not lower your risk of another heart attack. If you need to take NSAIDs for a long time, talk with your doctor to see if it is safe for you. Some research suggests that long-term use of these medicines may raise your risk for coronary artery disease.

If you need both aspirin and a pain reliever every day, talk to your doctor about what pain reliever you should take. If you take uncoated aspirin and ibuprofen at the same time, the aspirin may not work as well to prevent a heart attack. You may be able to use acetaminophen instead of ibuprofen to treat your pain. But if ibuprofen is your only option, avoid taking it during the 8 hours before and the 30 minutes after your aspirin dose.⁴ For example, you can take ibuprofen 30 minutes after your aspirin dose. If you take ibuprofen once in a while, it does not seem to cause problems.

Experts do not know if NSAIDs other than ibuprofen interfere with uncoated aspirin. Also, experts do not know if people who take a daily coated aspirin should be concerned about ibuprofen or other NSAIDs interacting with the aspirin. Talk to your doctor if you take these medicines every day.

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Citations

1. Krumholz HM, et al. (2001). Aspirin and the treatment of heart failure in the elderly. Archives of Internal Medicine, 161(4): 577–582.

2. Natarajan M (2002). Unstable angina. Clinical Evidence (7): 214–226.

3. Danchin N, Durand E (2006). Acute myocardial infarction, search date August 2004. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

4. U.S. Food and Drug Administration (2006). Concomitant use of ibuprofen and aspirin: Potential for attenuation of the anti-platelet effect of aspirin. Food and Drug Administration Science Paper. September 8, 2006. Available online: http://www.fda.gov/cder/drug/infopage/ibuprofen/science_paper.htm.