Harvard Heart Letter

Bleeding risk with aspirin must be balanced against benefit

An aspirin a day has been shown to lower the risk of a first heart attack in men and a first stroke in women, who are at increased risk for these events. But in a study published in the June 6, 2012 Journal of the American Medical Association, this practice increased the risk of major bleeding in the digestive tract or brain by 55% in people without diabetes. Study participants with diabetes had a 36% higher risk of bleeding, and aspirin use did not change this risk. These findings suggest that for the protective effects of aspirin to be greater than the risk of bleeding, aspirin users must have a 10%–20% risk of heart attack or stroke within 10 years. In those with a risk of 20% or higher, the benefits of aspirin would clearly outweigh possible harm. The authors recommended that anyone who has a history of internal bleeding, who takes drugs that increase the risk of bleeding, or who has an elevated risk due to advanced age not take aspirin to prevent heart disease.

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