Although aspirin is a very important drug, its use is now less common than it was ten years ago. Aspirin has long been acknowledged to provide a number of health advantages, but a recent study indicates that taking it along with some well-known medicines may have the opposite effect.

Aspirin has the potential to save some people’s lives. The drug helps a lot of patients who have a history of cardiovascular disease, ischemic stroke, heart attack, or who have had a stent put in their heart to increase blood flow.

But, if you are already on one blood thinner, new evidence suggests that you may not need to take a second one.

In fact, Michigan Medicine research suggests that patient’s risk of bleeding problems considerably decreases when they stop taking aspirin while taking a routinely prescribed blood thinner.

Over 6,700 adults treated at anticoagulation clinics in Michigan for venous thromboembolism, or blood clots, as well as atrial fibrillation, an abnormal heart rhythm that can lead to stroke, were studied. Despite not having a history of heart disease, patients were given aspirin in addition to the standard blood thinner warfarin as part of their treatment.

“We know that aspirin is not a panacea drug as it was once thought to be,” says Geoffrey Barnes, M.D., senior author of the study and a cardiologist at the University of Michigan Health Frankel Cardiovascular Cente, adding “and can in fact lead to more bleeding events in some of these patients, so we worked with the clinics to reduce aspirin use among patients for whom it might not be necessary.”

As a result of the research intervention, patient aspirin use dropped by 46.6%. With less aspirin use, the risk of a bleeding problem dropped by 32.3%. This means that for every 1,000 people who stop taking aspirin, one major bleeding problem is prevented. The findings are reported in the open-access journal JAMA Network.

According to Barnes, who is also an associate professor of internal medicine at the University of Michigan Medical School, when they began with this research “there was already an effort by doctors to reduce aspirin use,” and their results confirm “that accelerating that reduction prevents serious bleeding complications which, in turn, can be lifesaving for patients.” 

Several studies that looked at the use of aspirin and other blood thinners at the same time found some scary links between the two.

According to one study, patients with atrial fibrillation and VTE who were using warfarin and aspirin had more significant bleeding incidents and required more ER visits for bleeding than those who were only taking warfarin. Patients using aspirin and direct oral anticoagulants also had similar outcomes; they were shown to be more likely to experience a bleeding episode but not less likely to experience a blood clot.

“While aspirin is an incredibly important medicine, it has a less widely used role than it did a decade ago,” Barnes adds. “But with each study, we are seeing that there are far fewer cases in which patients who are already on an anticoagulant are seeing benefit by adding aspirin on top of that treatment. The blood thinner they are taking is already providing some protection from clots forming.”

Aspirin has the potential to save some people’s lives. The drug helps a lot of patients who have a history of cardiovascular disease, ischemic stroke, heart attack, or who have had a stent put in their heart to increase blood flow.

According to primary author Jordan Schaefer, M.D., a haematologist at U-M Health and clinical associate professor of internal medicine at U-M Medical School, the problem arises when certain persons take aspirin without a history of cardiovascular disease and are also administered an anticoagulant.

Many of these individuals were probably taking aspirin for the main prevention of heart attack or stroke, which is now known to be less effective than previously thought, and nobody stopped them when they began taking warfarin, according to Schaefer.

These results highlight the significance of just taking aspirin on your doctor’s advice and the need to consult your care team before beginning to take over-the-counter medications like aspirin to determine whether the benefit outweighs the risk.

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