Name Your Poison: Heart Attack or Puking Up Blood?

You have to give credit where credit is due – a recent analysis of studies looking at the benefits of aspirin therapy for people without a prior history of a heart attack managed to reduce the decision to a pretty simple bottom line: name your poison – a heart attack or puking up blood? We here at Doc Gurley really like this type of research – it translates a complex problem into something most people can get their heads around.

Researchers at Oxford looked at data regarding the benefits of daily aspirin for people without a prior history of heart attacks (no one’s questioning the benefits in people who’ve ALREADY had a heart attack – that’s very well established). Their analysis found that if you give a daily aspirin to a bunch of people who’ve never had a heart attack (95,000 in one study, 17,000 in another), you lower the risk for heart attack by

about a fifth, but you increase the risk for vomiting up blood/having blood in your stools (GI bleed) by about a third. To be even MORE specific, for every 10,000 people taking aspirin, you prevent five nonfatal heart attacks, but get one extra bleeding-related stroke, and three extra gastrointestinal bleeds.

So what should you do if you’re shaking out a baby aspirin into your palm every morning and staring at it, wondering whether to take it or not? It’s a decision best made between you and your doctor, but – in general – for Doc Gurley, it boils down to the fact that gastrointestinal bleeds are very treatable – as long as they’re recognized. If you get black, tarry stools, or vomit up blood, or even puke up something that looks like coffee grounds – you should get to the hospital pronto and, usually, treatment can have you good as new pretty fast. Heart attacks, on the other hand, are a bit trickier (and more time-limited) in terms of treatment. Heart attacks are also, ultimately, for most people (unless found clearly and VERY early), irreversible.

Finally, critics of the study point out that a lot of the data included people treated with whopping doses of aspirin (500 mg a day, as opposed to a baby aspirin, 81 mg a day) – and using a lower dose may tip the balance even further toward the benefits of heart disease prevention.

Bottom line: Ask your doctor about this new information, but for most patients, the benefits probably still outweigh the risk.

Bonus Points Take Home Message: It’s hard to give something to healthy people that will actually make them healthier - a strong argument against taking medicines indefinitely to prevent disease, unless the long-term data is really, really good.

Conspicuously Left Out Info: The data have never really supported giving an aspirin a day to asymptomatic (never had a heart attack) WOMEN. It’s only men this article is talking about…