Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet
Ischemic vascular disease is a term that describes a group of diseases caused by the buildup of plaque. Plaque is a waxy substance, known as cholesterol, that can build up inside blood vessels that supply oxygen to many vital organs in the body like the heart, brain, lung and kidney. This build up can narrow the blood vessels and reduce the flow of oxygen. When these vital organs are deprived of oxygen, it can lead to heart disease, or Coronary Heart disease, carotid artery disease or peripheral vascular disease.
Coronary heart disease is the leading cause of heart attack. Patients suffering from heart disease experience a decrease in the amount of blood which carries oxygen to the heart muscle. Signs and symptoms of ischemic heart disease may develop slowly over time or may arise quickly if an artery becomes blocked.
Carotid artery disease occurs if plaque builds up in the arteries on each side of your neck. This reduces the flow of oxygen to your brain. If oxygen is reduced or blocked, even for a small amount of time, brain cells may die and you may experience a stroke. Signs and symptoms of stroke include sudden weakness, paralysis or numbness of the face, arms, or legs. You may also have trouble speaking or seeing.
Peripheral vascular disease is a disease where plaque builds up in the arteries that carry blood to your arms, legs, kidney or stomach. When oxygen is reduced to these organs a patient may experience organ cell death leading to symptoms. Reduced oxygen to the legs can cause pain and numbness or to the kidney can cause the kidneys to stop functioning properly.
Some of the early indicators of ischemic vascular disease can be found during regular doctor visits and from routine blood tests. Having high cholesterol can be an early indicator of ischemic vascular disease because when cholesterol particles build up in the blood, they deposit inside the wall of arteries thus causing inflammation and narrowing the artery and reducing blood flow. Excess cholesterol that does not deposit on the artery wall can be measured in your blood during routine blood test. Inflammation within the arteries can trigger the formation of large clumps of blood known as blood clots. Blood clots help stop blood loss however when blood clots form inside a vein or artery and travel to the organs within the body they can block the flow of blood, thus reducing oxygen to those organs.
Aspirin and other antiplatelet medications are often used in the treatment of ischemic vascular disease. Aspirin is known as a blood thinner because it reduces your blood cells ability to stick together and form a clot. If you have ischemic heart disease, up until recently, you probably take a low dose of aspirin every day to prevent a heart attack. But the U.S. Preventive Services Task Force says people over the age of 60 should not start taking daily, low-dose aspirin and adults between the ages of 40 and 59 have a small benefit from daily aspirin use.
This recent recommendation addresses the use of aspirin in the prevention of a first heart attack or stroke however patients who have already experienced a heart attack or stroke or persons who have certain heart or blood vessel disease, atrial fibrillation, heart valve replacement, or persons born with heart defects may need to take aspirin or other antiplatelet to keep new clots from forming or getting bigger.
Aspirin continues to be the gold standard for treatment to prevent new clots from sticking and forming or getting bigger but there are other medications, known as antiplatelets, that prevent new clots from sticking together and forming as well. These antiplatelets include clopidogrel (Plavix), prasugrel (Effient) and Ticagrelor (Brilinta), cilostazol (Pletal) and dipyridamole (Persantine).
While aspirin and other antiplatelet drugs are life-saving medications they do have risks associated with their use. These medications may cause excess bleeding that can lead to weakness, anemia and even death. The risk of bleeding is increased when taken with other medications with antiplatelet activity or medications called anticoagulants which further disrupt blood clot formation.
Common adverse effects of aspirin or other antiplatelets are headache, nausea, diarrhea, bruising, nosebleeds, hemorrhage, blood in the urine, gastrointestinal bleeding, shortness of breath and aspirin-induced asthma.
Aspirin or other antiplatelets may interact with many commonly available over the counter medications. Oftentimes patients will take pain relievers or fever reducers over the counter along with their aspirin which can put them at risk of side effects. Talk to your doctor or pharmacist before taking pain or fever reducing medications over the counter with aspirin or other antiplatelets.
Some persons should not take aspirin or other antiplatelets for a short period of time. These medications should not be taken within 72 hours of major surgery or if you are sensitive or allergic to any of its ingredients. Other conditions may prevent you from taking these medications. Your doctor can best decide if aspirin or other antiplatelets are safe and effective for you to take.
You should not take daily low-dose aspirin on your own without talking to your doctor. The risks and benefits vary for each person.
If you have had a heart attack or stroke, your doctor may want you to take a daily low dose of aspirin to help prevent another. Aspirin is part of a well-established treatment plan for patients with a history of heart attack or stroke. Always follow the treatment plans your health care provider has recommended for you.
Because of the risk of bleeding, aspirin therapy is not recommended if you have never had a heart attack or stroke, except for certain carefully selected patients. If you’re over 70, taking aspirin to prevent a first heart attack or stroke could do more harm than good.
Because aspirin thins the blood, it can cause several complications. Tell your doctor if any of these situations apply to you. You should not take daily low-dose aspirin without talking to a doctor if you:
- Have an aspirin allergy or intolerance
- Are at risk for gastrointestinal bleeding or hemorrhagic stroke
- Drink alcohol regularly
- Are undergoing any simple medical or dental procedures
- Are over the age of 70
There is a risk of stomach problems, including stomach bleeding, for people who take aspirin regularly. Alcohol use can increase these stomach risks. If you are told to take aspirin, ask your doctor if it is safe for you to drink alcohol in moderation.
People with diabetes who do not have a history of heart attack or stroke may not need to take aspirin therapy, unless their health care providers specifically recommend it as part of the overall treatment plan.
How does aspirin help prevent heart attack and stroke?
Most heart attacks and strokes occur when the blood supply to a part of your heart muscle or brain is blocked. This usually starts with atherosclerosis, a process in which deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery. This buildup is called plaque.
Plaque usually affects large and medium-sized arteries. Plaques can grow large enough to significantly reduce the blood’s flow through an artery. But most of the damage occurs when a plaque becomes fragile and ruptures. Plaques that rupture cause blood clots to form that can block blood flow or break off and travel to another part of the body. This is called an embolism.
- If a blood clot blocks a blood vessel that feeds the heart, it causes a heart attack.
- If a blood clot blocks a blood vessel that feeds the brain, it causes a stroke.
Aspirin thins the blood, which helps prevent blood clots from forming.
Certain patients will be prescribed aspirin combined with another antiplatelet drug (such as clopidogrel, prasugrel or ticagrelor) – also known as dual antiplatelet therapy (DAPT).
Should I take aspirin during a heart attack or stroke?
The more important thing to do if any heart attack warning signs occur is to call 911 immediately. Don’t do anything before calling 911. In particular, don’t take an aspirin, then wait for it to relieve your pain. Don’t postpone calling 911. Aspirin won’t treat your heart attack by itself.
After you call 911, the 911 operator may recommend that you take an aspirin. He or she can make sure that you don’t have an allergy to aspirin or a condition that makes using it too risky. If the 911 operator doesn’t talk to you about taking an aspirin, the emergency medical technicians or the physician in the Emergency Department will give you an aspirin if it’s right for you.
Taking aspirin isn’t advised during a stroke, because not all strokes are caused by blood clots. Most strokes are caused by clots, but some are caused by ruptured blood vessels. Taking aspirin could potentially make these bleeding strokes more severe.