Can the "magic drug" aspirin prevent disease? Will long-term use increase the risk of cerebral hemorrhage?

Aspirin is a century-old medicine. Its anti-inflammatory and analgesic effects have kept many people away from illness. Now aspirin is more used in the clinical treatment of cardiovascular and cerebrovascular diseases.

In their clinical work, cardiologists often encounter patients who consult about the use of aspirin.

There is a very frequently asked question: Since aspirin can inhibit platelet function, will it weaken the body's coagulation function? Will long-term use increase the risk of cerebral hemorrhage?

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Let’s start with the characteristics of aspirin.

Aspirin can inhibit the formation of thromboxane A2 and produce an irreversible inhibitory effect on its induced platelet aggregation; it also has a blocking effect on phase II aggregation induced by adenosine diphosphate and adrenaline, and can inhibit platelet aggregation and release reactions caused by low concentrations of collagen, thrombin, certain viruses and bacteria, thereby reducing thrombus formation.

Judging from its mechanism of action, aspirin does weaken the body's blood coagulation function, so does it increase the risk of cerebral hemorrhage?

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Low-dose aspirin reduces risk of brain hemorrhage

Medical experts around the world have been conducting long-term experimental observations on whether aspirin increases the incidence of cerebral hemorrhage.

The results of the study showed that when taking high doses of aspirin (more than 325 mg per day), the patient's risk of intracranial hemorrhage increased by more than 25%.

A meta-analysis of patients taking low-dose aspirin (75-150 mg) showed that the incidence of intracranial hemorrhage in patients taking low-dose aspirin only increased by 0.02% within one year, which means that for every 10,000 patients treated, there were only approximately 2 additional cases of intracranial hemorrhage per year.

The three major misunderstandings about taking aspirin
Surveys show that many people take aspirin through "self-diagnosis". A study involving 68,000 patients published in the Journal of the American College of Cardiology (JACC) pointed out that more than 1/10 of the patients took aspirin improperly.

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Self-diagnosis, buy a bottle and eat it

Do not take aspirin without a professional doctor's evaluation. The risk of heart disease or stroke depends on many known and unknown factors. If the doctor does not accurately assess the patient's risk of heart disease and stroke, it may not be appropriate to use aspirin to prevent heart disease and stroke. Of course, if you stop using aspirin, you cannot stop it at will, and you also need to undergo a professional evaluation.

The "2019 Chinese Expert Consensus on the Use of Aspirin in the Primary Prevention of Cardiovascular Disease" points out that adults aged 40 to 70 years old whose 10-year expected risk of atherosclerotic cardiovascular disease (ASCVD) is ≥10% at the initial risk assessment, and who still have ≥3 major risk factors that are poorly controlled or difficult to change after active treatment intervention (such as a family history of premature cardiovascular disease) can consider taking aspirin to reduce the risk of ischemic cardiovascular disease.