4 ms·

There are risks to taking aspirin everyday, including an increased risk of hemorrhagic (bleeding) stroke, so it's important to weigh the pros and cons. That is

There are risks to taking aspirin everyday, including an increased risk of hemorrhagic (bleeding) stroke, so it's important to weigh the pros and cons. That is difficult before sufficient research has been done to identify who benefits and how much, but it's certainly something to consider.

AnimalMuppet 2y ago
OK, but... I am not a doctor. I don't even play one on TV. But if I understand correctly, there are two types of strokes: hemorrhagic strokes (strokes caused by bleeding in the brain) and... I don't know the technical term, but clot-based strokes (a blood clot blocks an artery in the brain). And if I understand correctly, clot-based strokes are something like 80% of strokes - they're four times as likely as hemorrhagic strokes. So isn't aspirin a net win anyway? You may increase your odds of a hemorrhagic stroke, but decrease your odds of the other kind of stroke, and the other kind is more common. (Unless you have some reason to think that you are more susceptible to hemorrhagic strokes than the other kind.) Corrections welcome, especially ones with data. Note well: This is not medical advice. Consult a doctor, not randos on the internet.
- leereeves 2y ago
  I'm not a doctor either, just a postgrad pre-med student with a heart problem (so I read a lot about the heart). I know just enough to be dangerous, but I do know you're right about the two types of stroke and the benefit of aspirin in preventing ischemic strokes (clots). And until recently, daily aspirin was recommended for that, even for people with no history of heart disease. But AIUI, now the American Heart Association (2019) [1], U.S. Preventive Service Task Force (2022) [2], and the European Society of Cardiology (2019) [3] all say that for people with no history of cardiovascular disease, daily aspirin has little to no net benefit in younger patients and increases mortality in older patients. Of course, the possibility of preventing metastasis adds another benefit, and may tip the balance back in favor of aspirin therapy. 1: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000678 https://www.ahajournals.org/doi/10.1161/CIR.0000000000000678 2: https://www.acc.org/latest-in-cardiology/articles/2022/04/27/20/41/new-uspstf-recommendation-on-aspirin-in-cvd https://www.acc.org/latest-in-cardiology/articles/2022/04/27... 3: https://www.escardio.org/static-file/Escardio/Guidelines/Publications/ANGINA/Q&A%20CCS%20Guidelines_23-10-19%20for%20web.pdf https://www.escardio.org/static-file/Escardio/Guidelines/Pub...
  - nartho 2y ago
    Is there any data about the cancer incidence in people who had to take aspirin daily for those reasons ?
    - leereeves 2y ago
      To be precise, this article isn't talking about aspirin preventing cancer, just stopping it from metastasizing. It links to data about that: https://pubmed.ncbi.nlm.nih.gov/22440947/ https://pubmed.ncbi.nlm.nih.gov/22440947/
- dragonwriter 2y ago
  You are assuming the pre-intervention incidence of each type of stroke is a guide to the effect size of the intervention on each, which isn't, as a rule, a justified assumption.
- Earw0rm 2y ago
  The main risk from aspirin isn't hemorrhagic strokes, it's GI bleeds. There are other blood thinners that are considered safer at an appropriate dose, including warfarin (the same stuff that, at higher doses, is used as rat poison). Getting dose right with this stuff is very important and varies from individual to individual. Not something that's ethical to mess with at "shotgunning the population" level (or even as a DIY thing), IMO.. there's a reason they put iodine and folate in bread, but not this stuff.
  - TheOtherHobbes 2y ago
    Warfarin has (mostly) been replaced by newer thinners like Dabigatran, Rivaroxaban, and Apixaban, which are much less dose dependent. Generally thinners are only given to people who have a moderate/severe risk of stroke or heart disease. All the thinners don't just depend on dose but also on (e.g.) the amount of Vitamin K from leafy greens. If we survive the next century (looking unlikely...) it's a fair bet that mixing AI analysis with live biochemical tracking and as-required synthesis would be the next Big Thing. Current medications are extremely crude and have hit-and-miss outcomes because the combination of diet, genetics, gender, activity levels, age, and stress (etc) all have huge effects on individual biochemistry.
bell-cot 2y ago
Note my prior "... anyone with serious cancer should (1) ..." disclaimer. If the cancer that you already have is (say) 10% likely to kill you, then waiting several years - for researchers to nail down details - is likely far riskier than taking aspirin now. (No, you can't be an idiot about it. Aspirin at 50g/kg would kill you faster than any cancer could, etc., etc.)
- m348e912 2y ago
  >(No, you can't be an idiot about it. Aspirin at 50g/kg would kill you faster than any cancer could, etc., etc.) If someone is dumb enough to down 9 lbs of Aspirin, it's on them.
- readthenotes1 2y ago
  If you're already on cancer, I'm wondering if you're already on other medical interventions, and now I'm wondering how aspirin will interact with those.

AnimalMuppet 2y ago

OK, but... I am not a doctor. I don't even play one on TV. But if I understand correctly, there are two types of strokes: hemorrhagic strokes (strokes caused by bleeding in the brain) and... I don't know the technical term, but clot-based strokes (a blood clot blocks an artery in the brain). And if I understand correctly, clot-based strokes are something like 80% of strokes - they're four times as likely as hemorrhagic strokes. So isn't aspirin a net win anyway? You may increase your odds of a hemorrhagic stroke, but decrease your odds of the other kind of stroke, and the other kind is more common. (Unless you have some reason to think that you are more susceptible to hemorrhagic strokes than the other kind.) Corrections welcome, especially ones with data. Note well: This is not medical advice. Consult a doctor, not randos on the internet.

leereeves 2y ago
I'm not a doctor either, just a postgrad pre-med student with a heart problem (so I read a lot about the heart). I know just enough to be dangerous, but I do know you're right about the two types of stroke and the benefit of aspirin in preventing ischemic strokes (clots). And until recently, daily aspirin was recommended for that, even for people with no history of heart disease. But AIUI, now the American Heart Association (2019) [1], U.S. Preventive Service Task Force (2022) [2], and the European Society of Cardiology (2019) [3] all say that for people with no history of cardiovascular disease, daily aspirin has little to no net benefit in younger patients and increases mortality in older patients. Of course, the possibility of preventing metastasis adds another benefit, and may tip the balance back in favor of aspirin therapy. 1: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000678 https://www.ahajournals.org/doi/10.1161/CIR.0000000000000678 2: https://www.acc.org/latest-in-cardiology/articles/2022/04/27/20/41/new-uspstf-recommendation-on-aspirin-in-cvd https://www.acc.org/latest-in-cardiology/articles/2022/04/27... 3: https://www.escardio.org/static-file/Escardio/Guidelines/Publications/ANGINA/Q&A%20CCS%20Guidelines_23-10-19%20for%20web.pdf https://www.escardio.org/static-file/Escardio/Guidelines/Pub...
- nartho 2y ago
  Is there any data about the cancer incidence in people who had to take aspirin daily for those reasons ?
  - leereeves 2y ago
    To be precise, this article isn't talking about aspirin preventing cancer, just stopping it from metastasizing. It links to data about that: https://pubmed.ncbi.nlm.nih.gov/22440947/ https://pubmed.ncbi.nlm.nih.gov/22440947/
dragonwriter 2y ago
You are assuming the pre-intervention incidence of each type of stroke is a guide to the effect size of the intervention on each, which isn't, as a rule, a justified assumption.
Earw0rm 2y ago
The main risk from aspirin isn't hemorrhagic strokes, it's GI bleeds. There are other blood thinners that are considered safer at an appropriate dose, including warfarin (the same stuff that, at higher doses, is used as rat poison). Getting dose right with this stuff is very important and varies from individual to individual. Not something that's ethical to mess with at "shotgunning the population" level (or even as a DIY thing), IMO.. there's a reason they put iodine and folate in bread, but not this stuff.
- TheOtherHobbes 2y ago
  Warfarin has (mostly) been replaced by newer thinners like Dabigatran, Rivaroxaban, and Apixaban, which are much less dose dependent. Generally thinners are only given to people who have a moderate/severe risk of stroke or heart disease. All the thinners don't just depend on dose but also on (e.g.) the amount of Vitamin K from leafy greens. If we survive the next century (looking unlikely...) it's a fair bet that mixing AI analysis with live biochemical tracking and as-required synthesis would be the next Big Thing. Current medications are extremely crude and have hit-and-miss outcomes because the combination of diet, genetics, gender, activity levels, age, and stress (etc) all have huge effects on individual biochemistry.

bell-cot 2y ago

Note my prior "... anyone with serious cancer should (1) ..." disclaimer. If the cancer that you already have is (say) 10% likely to kill you, then waiting several years - for researchers to nail down details - is likely far riskier than taking aspirin now. (No, you can't be an idiot about it. Aspirin at 50g/kg would kill you faster than any cancer could, etc., etc.)

m348e912 2y ago
>(No, you can't be an idiot about it. Aspirin at 50g/kg would kill you faster than any cancer could, etc., etc.) If someone is dumb enough to down 9 lbs of Aspirin, it's on them.
readthenotes1 2y ago
If you're already on cancer, I'm wondering if you're already on other medical interventions, and now I'm wondering how aspirin will interact with those.