For many years, aspirin was present in all Spanish medicine cabinets, either in its adult format or in its pediatric version. Before any cold, discomfort, flu or if the fever rose, aspirin was an infallible remedy. There were even people who took a daily pill to keep their pain at bay.
What happened to make it disappear is not clear. It is pointed out that it is an expensive medicine, that it can cause ulcers and bleeding, or that in the case of children it caused Reye’s syndrome (a rare pathology that causes inflammation in the liver and brain).
The fact is that this non-steroidal anti-inflammatory drug was gradually replaced by paracetamol and . But there are still many people who continue to take it by prescription, specifically those patients who have suffered a cardiovascular event.
Anticoagulant properties of aspirin
He doctor Marcelo Sanmartin Fernandeza cardiologist at , explains what this drug is and clarifies what its risks and benefits are.
“Aspirin or acetylsalicylic acid is an anti-inflammatory that, at low doses, is capable of inhibiting platelet function; something that other anti-inflammatories do not do. Platelets are key elements for the formation of clots within the blood vessels, especially those of the arteries”, details the specialist in cardiology.
That is, aspirin prevents platelets from aggregating and forming thrombi that could obstruct, among others, the coronary arteries (thus causing angina) or cerebral arteries (leading to a stroke). For this reason, says Dr. Sanmartín, “its protective role in myocardial infarction and heart disease has been studied and recognized”.
However, this effect of preventing platelets from clumping (antiplatelet effect) also explains why aspirin can cause bleeding: if platelets do not clumpe, thrombi do not form that clog arteries or veins in the event of bleeding.
When is it indicated then to prevent cardiovascular diseases?
Since they explain that people without known cardiovascular disease, the widespread use of aspirin to prevent heart attacks or strokes is not recommended because the risk of bleeding outweighs the possible benefit of the drug.
In Spain, there are around 100,000 admissions for myocardial infarction each year and between 90,000 and 100,000 for stroke. In these patients, “aspirin is the basic antiplatelet agent to prevent a second event,” as Dr. Sanmartín points out.
But even in these circumstances, there are situations in which it can be dispensed with. “This is the case, for example, of patients who must take anticoagulants, at least when more than 12 months have elapsed after a coronary stent implantation,” the cardiologist specifies.
On the other hand, some studies suggest that, when more than three months have elapsed since a stent has been implanted, it is more effective to use a single antiaggregant and, in this case, there are other drugs that have been shown to be superior to aspirin.
“However, it is not an approved practice in clinical practice guidelines. In most cases, we recommend two antiaggregants after a heart attack for about 12 months, but sometimes we can withdraw aspirin earlier and continue only with the second antiplatelet to avoid increased risk of bleeding. These antiplatelet agents, which are not aspirin, are more expensive drugs and not all patients would benefit from a change; perhaps only those with a very high risk of new heart attacks”, explains Dr. Sanmartín.
The cardiologist recalls that “medicine is a science that tries to adapt to each person, each patient.” For this reason, he concludes: “You have to trust the specialist’s recommendations, because he always tries to find the best for each patient, adapted to his clinical conditions. You don’t have to self-medicate.”