A Review of the Benefits and Risks of Aspirin Therapy

Aspirin is one of the over the counter drugs commonly used to provide relief from headaches. Sold in the Indian market under various brand names such as Aspro, Ecosprin and others, it has acetylsalicylic acid as its primary ingredient. Often referred to as a pharmaceutical milestone, the drug dates back to pre-World War I days, when it was discovered by a German chemist Felix Hoffman. Knowing the benefits and risks of Aspirin, can help you evaluate whether you are putting yourself at risk from hospitalisation by its regular consumption. After all, no one needs to go through the unnecessary trauma of hospitalisation even if covered by a health insurance plan.

Uses of Aspirin

It was right up to the 1970s that Aspirin was the drug of choice for pain relief and fever. Subsequently, the drug paracetamol, with the popular brand name, Crocin, became the drug of choice. Apart from its use as a pain reliever, Aspirin is often prescribed by medical practitioners as a blood thinning agent. People who suffer from high blood pressure, diabetes, heart problems, or those with blood flow issues, and habitual smokers are often prescribed aspirin in small doses on a long-term basis. It is also often prescribed for people with retinal damage as well as those perceived to be at a risk of colorectal cancer. Aspirin is also prescribed by Doctors, after a stroke or heart attack. 

Contra-indications

While having a stroke, Aspirin is to be avoided. Aspirin is also not recommended for children under 18. Those who take alcohol on a regular basis should only take aspirin under medical supervision. Those under regular medication for other conditions also should be circumspect while using aspirin as it is known to have a dangerous interaction with several drugs and reduces the efficacy of others. Aspirin is generally to be avoided in combination with ibuprofen and other anti-inflammatory painkillers, warfarin (a blood thinner), selective antidepressants and methotrexate, among others. The latter is used for the treatment of certain autoimmune diseases and cancer.

Aspirin in the Indian Market

The popularity of aspirin in India can be gauged from the fact that it is sold under more than 75 brand names in India alone. As per an article by the online news agency, The Print, Indians bought over 7 crore strips of Aspirin in 2018.  Much like the saying “an apple a day keeps the doctor away”, people often also say “an aspirin a day keeps heart attacks and strokes at bay”.

Controversies surrounding Aspirin Usage

Despite its popularity, there are several controversies that surround its use. The US Food and Drug Administration (FDA), is extremely clear in advising against the use of Aspirin without medical supervision even though it is available over the counter for headache and pain relief. While most labels on Aspirin under various brand names, mention the dosage of aspirin to be taken in case of headache and fever etc, the dosage for use as a preventive medication for myocardial infarction (MI) or ischemic stroke is not reflected on the label. In an explanatory brochure on the usage of Aspirin for prevention of heart attacks and strokes, the FDA emphasises the potential dangers of the use of aspirin, and the fact that long-term use can have side-effects, as well as the possibility of detrimental interaction if taken alongside other drugs.

Side Effects of Aspirin

There are several conditions under which the usage of aspirin is discouraged. People with severe renal failure (i.e. when the kidneys are unable to carry out their expected function of removing excess salt and water from the body), severe hepatic insufficiency (when the liver is unable to carry out its expected functions, such as production of bile, maintaining blood sugar levels, regulation of blood clotting etc), and those with sodium-retaining conditions, are advised against the usage of aspirin. Among some of the side effects of long-term usage of aspirin are elevated levels of hepatic enzymes, serum creatinine and blood urea. It can also increase the level of potassium in the blood stream and the levels of protein in the urine. The thinning effect of aspirin also means that in case of injury, the blood will take a much longer time to clot and therefore result in a more prolonged bleeding time. Aspirin is also said to increase the risk of bleeding in the brain and digestive tract, making it life-threatening in such cases.

Aspirin and Cardio-disease

Recent research points to the fact that prolonged use of aspirin does not lower an individual’s risk to heart attack. In a study published in 2018 by the New England Journal of Medicine, with a sample size of over 19,000 adults over the age of seventy, the researchers concluded that older adults who were given low-doses of aspirin as a preventive strategy did not benefit from lower risk to cardio disease. On the contrary, these adults were at a “significantly higher risk of major haemorrhage”. In another paper, by the same authors, using the same primary sample, the conclusion was that older adults who were apparently healthy, and who received daily aspirin demonstrated “higher all-cause mortality”

Thus, aspirin should be used with caution. For those who are on continuous low-dosage medication, it is advised to have the prescription reviewed, as current research clearly indicates that long term usage could have detrimental side effects and lower longevity in older adults. It should be only used by very select high risk patients as a preventive medication. As a remedy for headache, body ache, inflammation and fever, while there is no recent research dissuading its use, given the long-term effects, one should avoid “popping the pill” on a regular basis.