Daily low dose aspirin therapy (81 mg baby aspirin)

Aspirin is the brand name of an acetylsalicylic acid (ASA) OTC medication produced by Bayer and commonly used to treat pain, fever and inflammation. It belongs to a class of drugs known as NSAIDs, non-steroidal anti-inflammatory drugs, and besides its commonly known effect against inflammation, aspirin is also a blood thinner belonging to the class of antiplatelets, meaning it prevents platelets to stick to each other and to the walls of blood vessels, thus preventing clots.

As a blood thinner, aspirin is prescribed with a lower dose that ranges between 75 and 150 mg and commonly known as baby aspirin: in the USA it is commonly prescribed 81 mg per day, in the UK 75 mg per day, while in Europe it is generally prescribed 100 mg per day.

It has long been used in the prevention of strokes and heart attacks, also in healthy subjects, but new studies and evidence suggest it should not be used by the general population except in high-risk individuals and in those with history of stroke or heart attacks due to blood clots.

Some people with limited medical knowledge may think it is a good idea to take low dose aspirin as prevention strategy without consulting their doctor; it is estimated that over 6 million people in the USA take daily aspirin without history of cardiovascular disease and without their healthcare provider recommendation; if you are among them, you better think twice: not only it has been proven unnecessary in healthy individuals, but daily aspirin use also carries some risks such as an increased risk of bleeding in the brain or in the stomach.

Always consult your physician before taking a medication and take daily aspirin only after a consult and under the guidance of a health care provider.

Baby aspirin or low dose 81 mg aspirin for heart disease prevention

Is low dose aspirin the same as baby aspirin?

81 mg aspirin tablets were originally intended for use in children and for this reason they were also called baby aspirin. They are not to be used in children anymore unless it’s prescribed by a doctor and under the doctor’s supervision. While some people may still call it “baby aspirin”, a more appropriate name is low-dose aspirin.

Indications for low-dose aspirin (75-81-100 mg)

Daily low-dose aspirin therapy is usually indicated in the secondary prevention of cardiovascular disease (CVD) such as:

  • History of heart attack
  • History of ischemic stroke
  • History of heart by-pass surgery or angioplasty
  • History of angina

When it comes to primary prevention of CVD, meaning prevention without history of the disease, a risk/benefit analysis is needed. Some of the risk factors considered are age, sex, smoking, hypertension, diabetes, family history and cholesterol levels. Only use aspirin if clearly indicated by your physician.

Who should not take baby aspirin?

Never give aspirin to any child younger than 16 unless prescribed by a doctor because of a link with Reye’s syndrome.

Aspirin should also be avoided by people affected by some health conditions such as:

  • Bleeding and clotting disorders (bleeding easily)
  • Allergy to salicylates
  • Stomach ulcers
  • History of intracranial bleed
  • History of serious gastrointestinal bleed
  • Already prescribed with another anticoagulant or antiplatelet drug
  • Severe Kidney or liver disease

Only take baby aspirin if advised by a doctor.

Baby aspirin during pregnancy

Low dose 81 mg aspirin is recommended and commonly prescribed in pregnant women at high risk of preeclampsia. It is generally started between 12 and 28 weeks of gestation and continued until delivery. Low-dose aspirin is not recommended for the prevention of early pregnancy loss, fetal growth restriction, stillbirth, or preterm birth. Only take baby aspirin when and if advised by your gynecologist. While low-dose aspirin after the first trimester has not been found harmful, high doses of aspirin during the first trimester increase the risk of preterm birth, congenital defects and bleeding in the brain of premature infants.

What are the benefits of daily aspirin use?

A regular low-dose of aspirin decreases the risk of stroke and heart attacks in selected groups of patients by inhibiting platelets from sticking to each other or to blood vessels and causing blood clots. Blood clots can restrict or block blood flow and cause heart attacks, stroke and other serious health problems, including death.

Should you take low dose aspirin daily?

Daily low dose aspirin should only be taken if prescribed by a health care professional. It is generally indicated in people with history of cardiovascular disease (secondary prevention) and in those at high risk of cardiovascular disease and low risk of bleeding who fit into certain parameters (primary prevention).

Baby aspirin dosage and formulations

Depending on your country, there are different dosages and formulations available for low dose aspirin for primary and secondary prevention of cardiovascular events. Common dosages for this purpose are 75 mg, 81 mg and 100 mg.

Available formulations include the standard tablet, chewable tablet, soluble tablet, and coated tablet.

Higher dosages and different formulations are available for other indications of this drug.

Best time to take it

Low dose aspirin should be taken once daily, and it is best taken with or right after a meal. It is not advised to take it on an empty stomach as it will likely upset it.

Daily aspirin side effects

Daily aspirin use, like any other medication, my cause side effects. It commonly may cause upset stomach or mild indigestion. Bleeding more easily than normal such as with nosebleeds, having some bruises and cuts that take longer to stop bleeding are other common complications of this medication. Serious complications are rare and include severe bleeding, liver problems, and allergic reactions.

If you experience any side effect, contact your physician for advice.


Sources
  • Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly.
    JJ McNeil et al – The New England Journal of Medicine, Oct 2018
    DOI: https://doi.org/10.1056/nejmoa1805819
  • Effect of Aspirin on All-Cause Mortality in the Healthy Elderly.
    JJ McNeil et al – The New England Journal of Medicine, Oct 2018
    DOI: https://doi.org/10.1056/NEJMoa1803955
  • Effect of Aspirin on Disability-free Survival in the Healthy Elderly.
    JJ McNeil et al – The New England Journal of Medicine, Oct 2018
    DOI: https://doi.org/10.1056/NEJMoa1800722
  • Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial.
    JM Gaziano et al – The Lancet, Sep 2018
    DOI: https://doi.org/10.1016/S0140-6736(18)31924-X
  • Personalized Prediction of Cardiovascular Benefits and Bleeding Harms From Aspirin for Primary Prevention – A Benefit–Harm Analysis.
    V Selak – Annals of Internal Medicine, Oct 2019
    DOI: https://doi.org/10.7326/M19-1132
  • 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
    DK Arnett et al – Circulation, Mar 2019
    DOI: https://doi.org/10.1161/CIR.0000000000000678 
  • American Heart Association
  • Update on Aspirin in Primary Prevention.
    American College of Cardiology (ACC), Nov 2019
  • Low-Dose Aspirin Use During Pregnancy.
    American College of Obstetricians and Gynecologists (ACOG), Jul 2018
    DOI: https://doi.org/10.1097/aog.0000000000002708
  • Low-dose aspirin
    UK National Health Service (NHS)
    https://www.nhs.uk/medicines/low-dose-aspirin/
  • U.S. Department of Health and Human Services – Office of Disease Prevention and Health Promotion.
  • Aspirin use may be widespread despite new guidelines.
    US National Institutes of Health (NIH), Aug 2019

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