Aspirin – a cure all?

sotiris-antoniou-for-webBy Sotiris Antoniou, Consultant Pharmacist Cardiovascular Medicine, St Bartholomews Hospital, London

Every day there seems to be new research about aspirin, much of it contradictory. Interest in aspirin has never been greater, but is it really the cure-all it’s sometimes portrayed as in the media? And what should pharmacists be recommending to patients who come in self-medicating with low-dose aspirin?

Aspirin is now routinely prescribed for preventing heart attacks and strokes, and there is interesting evidence about its role in preventing cancer in certain cases, but the critical feature of safe and effective prescribing is balancing the risks and benefits of using this potent medicine for the patient as an individual. Aspirin is such a familiar drug that patients are often misled into thinking that it ‘can’t do any harm’ to take a low dose every day and need good information from pharmacists to understand the potential harms.

We know that being older, especially over 65, having a previous stomach bleed or ulcer and taking certain medication with aspirin can increase your risk of a future stomach bleed. Although rare, brain bleeds are also possible. These can be fatal, which means we should think carefully before prescribing aspirin in healthy middle-aged people.

All these factors need to be included in assessing whether aspirin is right for a patient or not. That is why aspirin is currently restricted to those who have established cardiovascular disease or have had a heart attack, as the benefits far outweigh the likelihood of a bleed.

Should everyone now be taking aspirin to prevent cancer? It’s very exciting that we are still finding out the benefits of a medicine that has been in use for so long. The data is encouraging, but as yet we still don’t have the “gold standard” clinical trial data that shows aspirin should be recommended as a “cancer-prevention” medicine for everybody.

I hope we continue to see trial results that show aspirin has benefits in preventing and treating cancer. However, patients must always be reminded that the best ways to reduce their risk of cancer are to stop smoking, maintain a healthy weight, cut down on alcohol consumption and exercise more.

So – not a cure-all, but a vitally important medicine that has benefited patients enormously and is still yielding data on new uses. In that sense it’s truly a wonder-drug.