Aspirin dose 80 mg, 325 mg for heart health, blood thinning
What is the right dose of aspirin for heart attack prevention? Recommendations based on health and medical condition
May 3 2018 by Ray Sahelian, M.D.

Aspirin acts as a blood thinner which is believed to account for much of its benefit of protecting against heart attacks and strokes. But that same action, along with a tendency to deplete the stomach's protective lining, can lead to a danger of gastrointestinal bleeding and possibly bleeding in the brain. Some research indicates that intake may reduce certain forms of cancer.
   Despite hundreds of clinical trials the appropriate dose of aspirin to prevent myocardial infarction and stroke is still uncertain. In the US the doses most frequently recommended are 80 mg, 160 mg, or 325 mg per day. Because aspirin can cause major bleeding, the appropriate dose is the lowest dose that is effective in preventing both MI and stroke because these two diseases frequently co-exist. Aspirin use for preventing heart attacks is underutilized. Its regular use, but not other nonsteroidal anti-inflammatory drugs (NSAIDs), is associated with a reduced incidence of cancer and cancer-related deaths, particularly among former smokers and those who never smoked. NSAIDs include commonly used analgesic drugs, such as ibuprofen and naproxen, that are usually available over-the-counter.

Comparison to dietary supplements that thin the blood
There are natural alternatives to aspirin that are just as effective in thinning the blood, for instance fish oils and garlic. This article on blood clots mentions a number of these blood thinning natural alternatives.

How much fish oil capsules, ginkgo biloba, EGCG, etc. would it take to equal the dosage (or rather, blood thinning effects of) a baby aspirin?
   I am not aware of such comparison studies so it is difficult to say. Furthermore the dietary supplements have influences on the body that are very different than aspirin even though they have blood thinning potential as a commonality. It is not known at this time whether taking fish oil capsules or eating more fish reduces or eliminates the need to take aspirin. It is likely that the dose of aspirin could be reduced in those who take fish oils supplements.

Guidelines from the U.S. Preventive Services Task Force
Aspirin recommended for: Some men 45 and older with risk factors for heart disease, assuming no history of ulcers or other bleeding dangers. Some women 55 and older with risk factors for stroke, and no history of bleeding danger.

Aspirin not recommended for: Men younger than 45, and women younger than 55. Anyone 80 and older.

Note: Aspirin therapy may help reduce the risk of heart attack by thinning the blood and preventing clots. But it's not safe for everyone. You should be wary of aspirin therapy if you: Have kidney or liver disease. Drink three or more alcoholic beverages daily. Have uncontrolled high blood pressure. Take a blood-thinning medication or several herbal supplements that thin the blood. Have any possible symptoms of stroke.
Aspirin for heart attack prevention
My personal opinion is that aspirin, in a dosage of 81 mg 2 times a week, should provide enough benefits and at the same time minimize the risk for stomach ulcer or bleeding. There is no need to take higher dosages for cardiovascular health.

In patients with both stable coronary disease and atrial fibrillation, a baseline treatment of aspirin and an oral anticoagulant is often prescribed due to the hoped benefits of each therapy on cardiovascular and thromboembolic events and mortality. However, recent studies in this population have shown that adding aspirin to an oral anticoagulant is not associated with a reduction in recurrence of coronary or blood clotting events, but significantly increases the bleeding risk. In these patients, in particular when their bleeding risk is high, aspirin withdrawal may be considered.

Daily low-dose aspirin therapy may not have significant heart-health benefits for older people. A study, which involved more than 14,000 Japanese people aged 60 to 85, found no major difference in heart-related deaths or non-fatal heart attacks and strokes between people who took aspirin and those who didn't,  Journal of the American Medical Association, online; Nov. 17. 2014.

Should you stop your daily aspirin use?
Many doctors recommend their healthy patients to take a daily dose of aspirin in order to prevent heart attacks. Do the anti-coagulant benefits trump the potential risks, or vice versa? The results of the Aspirin for Asymptomatic Atherosclerosis (AAA) study found that the risks of bleeding from taking aspirin were such that its routine use in healthy people was not advised, although the researchers did agree its benefits in patients with a history of vascular problems such as heart attack or stroke. Professor Peter Weissberg, medical director of the British Heart Foundation which helped fund the research, says, "The findings of this study agree with our current advice that people who do not have symptomatic or diagnosed artery or heart disease should not take aspirin, because the risks of bleeding may outweigh the benefits." The study was led by Professor Gerry Fowkes from the Wolfson Unit for Prevention of Peripheral Vascular Diseases in Edinburgh, Scotland, and presented at the European Society of Cardiology Congress in Barcelona in August 2009. The study involved 3,350 men and women aged 50 to 75 years who tests revealed may have a condition where the arteries in their legs were narrowed -- but who had no symptoms of heart disease or history of heart attack. They were given either a daily 100 mg dose of aspirin or a placebo and monitored over eight years. While there was no difference in the number of heart attacks, strokes and other cardiovascular events, major bleeding occurred in two percent of the aspirin group compared to just 1.2 percent of the placebo group.
    Comments: If you have no vascular problems, it is not necessary to take aspirin. If you wish to take it, limit your dosage to a baby aspirin two or three times a week rather than daily. A baby aspirin has 81 mg. Also consider fish oil softgels or other herbal supplements and herbs, such as garlic, since they can help with thinning the blood.

Aspirin side effects
Though medical journal articles endlessly promote the use of aspirin to ward off blood clots, heart attack and stroke, the U.S. Food and Drug Administration says daily aspirin therapy isn't for everyone. Is it possible that long-term daily use of aspirin in healthy people is unnecessary? While aspirin can help those at risk of heart attack or stroke by preventing the formation of dangerous clots, unwanted side effects could also include stomach bleeding, bleeding in the brain, and kidney failure. Easy bruising is also bothersome for many people taking aspirin.
   Dr. Sahelian says: One option is to take a baby aspirin two times a week and hence minimize the potential side effects from aspirin use.

J Gastroenterol. 2014. Small bowel injury in low-dose aspirin users. The use of low-dose aspirin (LDA) is well known to be associated with an increased risk of serious upper gastrointestinal complications, such as peptic ulceration and bleeding. Until recently, attention was mainly focused on aspirin-induced damage of the stomach and duodenum. However, recently, there has been growing interest among gastroenterologists on the adverse effects of aspirin on the small bowel, especially as new endoscopic techniques, such as capsule endoscopy (CE) and balloon-assisted endoscopy, have become available for the evaluation of small bowel lesions.

Q. If aspirin causes stomach and intestinal bleeding, why not a sublingual approach?
   A. That could help reduce the intestinal bleeding risk but if used inappropriately bleeding can still happen in other areas of the body.

Rebound effect
I am a 61 year old healthy male and have been taking 81mg of aspirin for  several years. I have no history of a heart condition. Recently I read about the rebound effect if I was to stop taking the aspirin. I want to know if I should be concerned about any rebound effect if I cut back to every other day.
   A. I am not too informed yet about a "rebound effect." I have not seen enough data on this topic.

Aspirin or Plavix?
Adding the blood-thinning drug Plavix to a daily dose of aspirin does not lower the risk of death, heart attack or stroke in high-risk patients. In a study of more than 15,000 patients, combining Plavix, sold by Sanofi-Aventis SA and Bristol-Myers Squibb Co., with aspirin may do more harm than good for patients at risk of developing heart disease, but it can help those who have already suffered a heart attack or stroke. The results confirm that aspirin is "the gold standard" for treating heart risk. Plavix is the current standard treatment among so-called anti-platelet drugs, which are used to prevent blood clots that can cause a heart attack, unstable angina, or stroke. Aspirin, also a blood thinner, acts on a different platelet receptor than Plavix, which has more potent effects. The trial results confirm that aspirin has the best benefit-to-risk and the best benefit-to-cost ratios of other blood thinning drugs.

Aspiring and nattokinase
Q. I read online on a different website that it is ok to take Nattokinase if you are on a low dose aspirin, you say different. I am taking both. How would I know if I have internal bleeding?
   A. Small amount of internal bleeding can occur without symptoms.

Aspirin equally good in men and women
Some studies have suggested that aspirin is less effective for preventing heart attack in women than in men, although women do benefit from a similar reduction in risk of stroke due to a blocked artery. However, other studies show both a man and a woman benefit from low dose aspirin use. Overall, though, it appears that women with a low or average risk of having a heart attack are not likely to get much of benefit from aspirin use for heart attack prevention. Perhaps fish oils are just as good for blood thinning.

Bladder cancer
Dr. Jason R. Gee at the University of Wisconsin-Madison, has determined that the use of aspirin reduces recurrence of superficial non muscle invasive bladder cancer. British Journal of Urology International 2009.

Blood clots
J Thromb Haemost. 2014. Why does aspirin decrease the risk of venous thromboembolism? On old and novel antithrombotic effects of acetyl salicylic acid. It is well established that aspirin, an irreversible inhibitor of platelet cyclooxygenase activity, is effective in secondary prevention of arterial thromboembolic events. The pooled results of the recent randomized, multicenter WARFASA and ASPIRE aspirin trials showed a 32% reduction in the rate of recurrence of venous thromboembolism (VTE) in patients receiving aspirin following VTE. These clinical data support evidence that platelets contribute to the initiation and progression of venous thrombosis and aspirin inhibits thrombin formation and thrombin-mediated coagulant reactions. In addition to the known acetylation of serine 529 residue in platelet cyclooxygenase-1, the postulated mechanisms of aspirin-induced antithrombotic actions also involve the acetylation of other proteins in blood coagulation, including fibrinogen, resulting in more efficient fibrinolysis.

Aspirin for colon cancer
The risks of aspirin, including stomach bleeding, outweigh its potential benefits in preventing colon cancer in people who have just an average risk of cancer, unless the dose of aspirin is very small and the drug is not taken every day. People with no reason to believe they have a high likelihood of colorectal cancer, including those with a family history of the disease, should not take high dose aspirin or other non-steroidal anti-inflammatory drugs to try to prevent it. But people who take aspirin to prevent other conditions such as heart disease should continue to discuss with their doctors whether it is worthwhile. Taking more than 300 mg per day of aspirin, ibuprofen or other similar drugs, known as NSAIDs, can cause hemorrhagic stroke, intestinal bleeding or kidney failure. Low doses of aspirin, less than 100 mg every other day, can reduce the risk for heart disease but its influence on colon cancer is still not fully understood.

Taking aspirin every day appears to reduce the odds of developing and dying from colon, stomach or esophageal cancer, Aug. 6, 2014, Annals of Oncology.

Aspirin for heart attack prevention
Although it's well known that taking aspirin regularly can lower a person's risk of heart disease, few Americans, it seems, use the common pain reliever for heart health. Use of aspirin for the prevention of a first or second heart attack or stroke is very low, even among adults at increased risk for such events. Large numbers of people at relatively high risk for heart attack and stroke just aren't getting a recommendation from their doctor to take aspirin, or if they are getting it they aren't hearing it. 

Q. A recent angiogram has revealed that I have blockage in a smaller artery traversing the left side of my heart. The cardiologist did not want to try stenting, as he feels it would likely re-block and it may do harm to larger arteries in trying to reach the smaller restricted artery. I am taking two blood pressure meds and Vytorin. The cardiologist has also prescribed a daily aspirin tablet. In his book on reversing heart disease, Dean Ornish cites clinical trials that indicated that aspirin reduced the number of heart attacks, BUT it also had negative other effects - - e.g., an increase in hemorrhagic strokes and ulcer problems. Do you have a general opinion on the advisability of an aspirin regimen? Thank you.
   A. There is a wide range of opinions among doctors regarding the appropriate dosage of aspirin. My personal opinion is to use a baby aspirin a few days a week and to also take fish oil capsules or krill oil capsules along with a higher consumption of a variety of vegetables.

Aspirin and sleep
A small amount does not have much of an influence, but a high dose could interfere with sleep patterns.

Electroencephalogr Clin Neurophysiology. 1980.
Two groups of 8 females were given either 3 times 600 mg aspirin or placebo daily for 4 days. With aspirin, slow wave sleep was significantly decreased and stage 2 sleep significantly increased. Aspirin also significantly disrupted intra-subject night-to-night continuity of several sleep stages during drug and recovery nights.


Q. Is it true that EGCG, the extract from green tea, can inhibit platelets similar to aspirin?
   A. We have seen one such study comparing aspirin and EGCG.

I have a question about taking one 325mg tablet of aspirin three hours prior to taking 1000 mg of ibuprofen. Could this lead to an accidental OD?
   I think taking aspirin and ibuprofen can increase the risk for bleeding and stomach ulcers.

Platelet aggregation inhibitors in hot water extract of green tea.
Chem Pharm Bull (Tokyo). 1990. Ito-en Central Research Institute, Shizuoka, Japan.
The effect of hot water extract of green tea on the collagen-induced aggregation of washed rabbit platelets was examined. The extract lowered submaximal aggregation and prolonged the lag time in a dose-dependent manner. After fractionation of the extract, it was revealed that the tea catechins (tannins) are active principles for inhibition and that ester-type catechins are more effective than free-type catechins. One of the ester type catechins, epigallocatechin gallate ( EGCG ), suppressed the collagen-induced platelet aggregation completely at the concentration of 0.2 mg/ml. Comparing IC50 values of EGCG and aspirin it was found that the potency of EGCG is comparable to that of aspirin. Thrombin- and platelet activating factor (PAF)-induced aggregation was also inhibited by EGCG. The elevation of cyclic adenosine 3',5'-monophosphate (cAMP) level was not observed in EGCG treated platelets.

Q. I would be grateful for your thoughts on taking Ginkgo biloba and aspirin. The combination is stated to be inadvisable because of enhanced bleeding risk. Should a person starting ginkgo stop aspirin entirely ? How great is this stated risk ? Would taking ginkgo say 120mgm a day, substitute entirely for taking 100 mg enteric coated aspirin daily? There must be some stated comparison between the two. If there is not please let me know.
   A. We are not aware of any studies that have compared the blood thinning properties of ginkgo biloba versus aspirin. Whether to use ginkgo along with aspirin may depend on the dosage used and a person's inherent clotting baseline which is different from person to person.

Q. In terms of being a blood-thinning agent, what is the equivalency of 1 fish oil capsule (1000 mg) compared to a baby aspirin (81 mg)? In other words, how many 1,000 mg. fish oil capsules would it take to equal a baby aspirin?
   A. This is a good question and I don't have a good answer. I have not seen studies comparing the blood thinning properties of fish oils compared to aspirin.

Does silibinin extract interfere with the blood thinning effect of aspririn?
     Probably not but I am not sure.

I read your report about the daily aspirin and its influence on heart patients. A group has requested for me to locate a KOSHER aspirin since most do not have that certification. I located an aspirin that is KOSHER, however they come in dosage of 100mg only. I am interested in importing that product, however I am concerned about the dosage. Would the 100mg be less benefit since it carries more bleeding risks. Can it be worked out to be taken less times per week and in fact it would be even of more beneficial.
    A baby aspirin is 91 mg while a regular aspirin is 325 mg. There is no major difference between 81 mg and 100 mg and the stronger one can be taken less frequently.

I am 46. I take a 81 mg aspirin every day, also Prilosac for my acid. My question is, does Prilosac block aspirin benefits.
    Prilosec (omeprazole) is used to treat symptoms of GERD and other conditions caused by excess stomach acid. Some studies indicate the use of this medication reduces the absorption of aspirin although the clinical significance is not fully understood.

Everywhere we read that people over 50 should take a low dose aspirin each day for heart attacks in men and stroke prevention in women. Some doctors recommend to take 2 baby aspirin daily. SO - I know it can cause bleeding in GI tract - and there is enteric coated to prevent this bleeding BUT I like to use natural or alternative things when I can. Since the aspirin I believe is used to prevent the clots that cause strokes &heart attacks or at least thin them, would the following be good or what can you suggest? Garlic Nattokinase Coq10 grape seed Xtract guggull carnitine, just dont know who to ask - my MD is clueless.
    There are no easy answers since each person has a different blood clotting or thinning predisposition and each person has a different diet. As a general rule I prefer to limit baby aspirin use to once or twice a week and have a higher intake of several herbs and nutrients that thin the blood.

I struggled with sleep issues for a couple of decades. Was diagnosed with SAD, and delayed sleep phase syndrome. Actually, although my sleep cycles were always out of whack, the quality of my sleep was terrible. Although lack of sun didnít help and light therapy did. Sleep remained a problem. I came across theanine in 2009 and have been using it since. It helped where all kinds of drowse inducing supplements have not. It helped whatever sleep I was getting be of better quality. I tried many other supplements like melatonin, 5HTP, chromium, pine bark, sam-e, fish oil, negative ionizers, turmeric, rhodiola, and a long list of things that is too lengthy to delineate here. None of it worked. Lots of experimentation. Also tried yoga, am a daily tai qi practitioner, among other things. Still, deep sleep remained elusive and gradually got worse from 2011-2014.A few months ago, I took aspirin for a bad sinus infection and slept like I havenít in years. I didnít connect the unusual improvement in sleep quality to aspirin. Took aspirin again for muscle soreness a couple of months later and noticed amazing sleep and realized it was not a coincidence. I decided to try a daily baby aspirin just before bed since then and I have consistently been getting normal sleep ever since. Its basically miraculous. Just wanted to add for the sake of accuracy - my comments above about aspirin and sleep were with a regimen of 300-400mg of theanine nightly (and a small amount of valerian, passion flower and lemon balm. Aspirin clearly does have an effect on sleep in my experience and was the turning point in my getting a basically normal night of sleep but again with the theanine.

I just tutned 65 years old female and for 2 years and currently taking 80 mg valsartan and 40 mg of atorvastatin nightly that my dr prescribes my blood pressure is always 120/80 I have no diabetes and no cholesterol and labs are good I have been smoking for past 40 years and currently smoke half pack to 1 pack a day my dr just told me yesterday to start a baby aspirin 81 mg daily I think I only want to take it twice a week is this ok?
   A. I am not in a position to suggest a specific dosage or frequency of use, each person is different in what they need. However, you could also consider other natural blood thinners as reviewed in my article on blood clot.