Many doctors are still likely to advise daily, low dose aspirin for cardiovascular disease prevention, even though doing so carries significant risks, in the last five-year guidelines for aspirin and primary cardiovascular diseases prevention have changed because aspirin can put individual at an increased risk of bleeding and anemia.

Using aspirin to ward off heart attack and stroke (Aspirin for Cardiovascular Disease) used to be a no-brainer. Doctors previously recommended aspirin for both primary and secondary prevention of cardiovascular disease.

Aspirin is a blood-thinner, meaning that it has anticoagulant or antiplatelet properties, which make it difficult for blood to clot. These properties are useful for preventing heart attack and stroke but can cause other health issues, namely increased bleeding risk. The kind of bleeding that led to the change in guidelines was all kinds of bleeding. So, it is falling and hitting the head, but it’s a lot of spontaneous bleeding in the stomach.

For older adults, falling can be a serious health concern. When combined with an increased bleeding risk due to aspirin, increased intracranial bleeding, that if they haven’t had a stroke before, that you’re putting them at risk for bleeding; this is a potentially fatal mixture.

However, following the results of three major aspirin trials in 2018, guidance around aspirin has shifted. It is generally no longer recommended for individuals who have not had a heart attack or stroke (Aspirin for Cardiovascular Disease).

However, aspirin is still recommended for patients who have already experienced a cardiovascular event and are trying to prevent another from occurring.

Aspirin no longer carries a blanket recommendation because of the potential risks it carries, particularly bleeding risk and anemia (25-30% higher risk – body doesn’t produce enough healthy red blood cells to transport the necessary amount of oxygen, leading to shortness of breath, dizziness, and headaches).

In a research letter published in the Annals of Internal Medicine, researchers found that 18.5 million individuals aged 60 or older, about one in three, were still using aspirin for primary prevention of cardiovascular disease. Many of them, about 3.3 million, were doing so without medical advice. 

“This practice was supported by evidence prior to 2018. It naturally takes some time for new data to percolate and reach physicians and patients and for these to translate into changes in management. Potentially, there may also be a component of lack of awareness and hesitancy to change medical management,” Qaisar Ahmed, MD, DHMS a Cardiology Fellow at Dnepropetrovsk state medical academy, Ukraine, told Healthline.