Should you take aspirin as a blood thinner to prevent heart attacks? An aspirin a day is not a one-size-fits-all approach to picture-perfect health.

How Often Can You Take Aspirin?

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

Aspirin and Heart Attacks

There’s a popular myth out there… that an aspirin a day is a good strategy for preventing heart attacks or strokes in the first place, i.e. for primary prevention.

Fact is, it’s not, mainly because it is not really a safe drug: it can cause GI bleeding. Aspirin is beneficial as a strategy for secondary prevention, i.e. for people who have already had a heart attack, stroke, bypass surgery, angioplasty, or stent insertion.

My Thoughts? It’s simple. Don’t take an aspirin a day unless you have diagnosed arterial disease. If your doctor wants you to take aspirin for diagnosed heart disease, have a discussion about aspirin dosage and side effects first, and be on the alert for any GI upset or stool discoloration. Report to your doctor immediately if something isn’t right. For preventative measures, I prefer to use aspirin alternatives like nattokinase, fish oil, garlic, ginger, and turmeric instead. They are useful and safe natural blood thinners.

The Details on “an Aspirin a Day”

This tried and somewhat true cardiovascular mantra has been around as long as I can remember, a popular and inexpensive approach to help keep blood thin and prevent clots that trigger heart attacks and stroke.

Doctors often prescribe aspirin for both primary and secondary prevention but are always concerned about the threat of GI tract bleeding. The fact is that as many as 19,000 deaths a year are thought to be due to aspirin usage.

In my clinical practice, new patients would typically ask me about taking aspirin, even healthy patients wanting to improve their cardiovascular status. My answer: If you have arterial disease, an aspirin a day may be worth considering to keep the blood thin. If you don’t have it, forget the aspirin. The natural blood thinners don’t carry a risk for intestinal bleeding.

Among these new patients were individuals already taking aspirin for primary prevention (their doctors had told them to do so or they were doing it on their own based on hear-say). Quite a few had symptoms of aspirin side effects, including overt bruising and gastrointestinal bleeding. I got them off of that habit in a hurry.

According to recent guidelines from the U.S. Government’s Preventive Services Task Force, men from 45 to 79 should take an aspirin a day only when the potential benefits of a reduction in heart attack and stroke outweighs the potential harm of increased gastrointestinal bleeding. For women 55 to 79, the same recommendation applies for a potential benefit of a reduction in strokes. Neither men under 45 nor women under 55 are encouraged to use aspirin for cardiovascular disease prevention. As far as both genders over 80 years of age, there is no sufficient evidence to assess the balance of benefit and harm for prevention.

Aspirin as a Blood Thinner

Aspirin’s appeal comes from its ability to block the formation of thromboxane A2, a substance produced by activated platelets, cells in the blood that contribute to clotting. Too many platelets means too much clotting, a danger for people with occluded arteries to the heart and brain. More platelets also mean too much thromboxane, which makes things worse by constricting blood vessels. Too few platelets and you run the risk of bleeding.

Baby Aspirin vs. Aspirin?

  • If I have cardiovascular disease, what strength aspirin should I use – a baby aspirin (81 mg) or a regular strength (325 mg)?

The issue is tolerance. I had perhaps a couple of dozen patients over the years who complained of GI upset, heartburn, or dark stool (a sign of GI bleeding) as a result of taking aspirin. In my practice I usually recommended 1 or 2 baby aspirins, depending on the situation, and I rarely had a problem. People were able to tolerate that dosage much better.


© 2013, 2016 HeartMD Institute. All rights reserved.

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  1. Maria

    on February 17, 2014 at 8:26 am

    I was diagnosed a while ago with APA syndrome, I was put on Aspirin 81 mg and did help me carry my pregnancies through. I have stopped taking aspirin because I would bruise so much and I just didn’t want to take it anymore.
    Should I take Nattokinase, which I purchased at health store for preventative measures?
    Can APA syndrome recess on its own.

  2. christopher davids

    on April 4, 2014 at 10:12 am

    I have stents in place staring in 1998. I have been advised to take an aspirin a day but have not. I am wondering whether nattokinase can substitute for aspirin in patients who have had stents

  3. Phyllis

    on June 12, 2014 at 5:36 pm

    I was recommended baby aspirin because of arrhythmia. My mother died of a massive duodennal ulcer. Can I use nattokinase instead of aspirin?

  4. betty

    on May 28, 2015 at 6:22 pm

    Have you ever heard of anyone, who after on 2 baby aspirin a day for about 6 weeks, started developing bruises with subcutaneous nodules that stay and spread after the bruise resolves? This started on my right forearm 2 weeks ago, just had one lump sent as biopsy. This morning found another forming on left inner thigh. Cut the aspirin to one a day about a month ago due to lots of little bruises. Stopped completely maybe week or so later due to headaches and fearing a brain hemorrhage. Lump/bruise came about a week later. Please tell me this is a known possible aspirin reaction, as I am afraid it could be something much worse. Betty

  5. Joanne

    on January 3, 2018 at 8:03 am

    I have been diagnosed with a fib, chronic arrhythmia and take a low dose aspirin, 81 mg a day, recently increased dose to 81 mg twice daily as a preventative for stroke. Should I continue one dose twice a day, or would two 81 mg dose once a day be better? I’m 62 years old in otherwise good health and didn’t want to be put on a rx drug. I take bio identical hormone in cream form as only RX I am on. Have also wondered if I should consider a pacemaker?

  6. HeartMD Editor

    on January 5, 2018 at 10:06 am

    Hi Joanne,
    Thank you for your comment. Unfortunately, we can’t advise you on medications or if a pacemaker would be a good choice for you. This would be a question you would have to discuss with your doctor. If you would like a second opinion from an integrative doctor a good resource is Dr. Sinatra’s Top Docs list. You can see it here.

  7. J mccann

    on April 13, 2019 at 6:27 pm

    I take all of alternatives plus 325 asprin

  8. Bruno

    on June 3, 2019 at 8:41 pm

    I have been thinking of getting a earth grounding blanket…. I have been taking 81 mg aspirin for many years after radical prostatectomy that included blood clots ..this was 17yrs ago….
    I have read that if you are on blood thinner medication you should not use earth grounding devices.
    What do you think

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