Harvard Health Letter

Missing out on aspirin therapy?

Research finds most people skip the proven measure.

Aspirin or another type of antiplatelet medication is usually prescribed after a heart attack or a diagnosis of cardiovascular disease (CVD). But a recent report by the Centers for Disease Control and Prevention found that fewer than half of the people with CVD in the United States are prescribed antiplatelet therapy. Even when it's prescribed, that doesn't mean patients are taking it as directed. "It can have side effects, like stomach upset or nosebleeds. These side effects can lead people to stop taking it without telling the doctor," says Dr. Deepak Bhatt, a cardiologist with Brigham & Women's Hospital. "Also, many of the patients prescribed aspirin start to feel well once they've recovered after a heart attack, and mistakenly conclude they don't need to take aspirin."

How aspirin works

Aspirin helps prevent future heart attacks by helping to keep platelets in the blood from sticking together and forming clots that block blood flow in one of the heart's arteries—a process that can result in a heart attack. If you have CVD, you may be prescribed another type of antiplatelet medication, such as clopidogrel (Plavix), instead of or in addition to aspirin. However, some studies have shown that taking both medications is not significantly more effective than taking just one.

Aspirin's ability to reduce the blood's tendency to form carries a risk of bleeding. "The most common site of serious bleeding is the digestive system, in particular the stomach," Dr. Bhatt says. "Very rarely, bleeding into the brain can occur, which can be catastrophic. In patients at high cardiovascular risk, such as those with prior heart attacks, the benefits of aspirin outweigh the risks." He adds that people with peripheral artery disease (significant plaque buildup in the leg arteries) should also be on antiplatelet therapy.

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