To many adults, aspirin (ASA) is a medicine cabinet staple. Great for headaches, it reduces fever and acts as an anti-inflammatory agent to minimize pain. Over the last 50 years, doctors have found even more uses for this inexpensive little tablet. The American Heart Association now recommends low dosages of aspirin for patients who’ve had a heart attack, unstable angina, ischemic stroke caused by a blood clot, or transient ischemic attacks better known as TIAs or “little strokes”. Clinical trials show that aspirin can help prevent a recurrence of these events because it blocks certain substances – prostaglandins and thromboxanes – which are involved in producing pain, inflammation and blood clotting. Yet as with anything – there are two sides to the story – the good news and the potential bad news – or side effects.
Because aspirin is such a complex and important medicine, we will cover this in a two part series. This article will describe the history and basics – next week’s article will dive deeper into the newer uses for ASA – including daily low dosage and the potential side effects as well as dietary management.
So what is so important about the history and proper usage of aspirin? Because knowing how and why aspirin works can help you take the right kind and right dosage and help you better work with your doctor to minimize serious negative side effects by understanding how your lifestyle may impact your dosage.
Aspirin in its most basic form has been around since ancient times – some findings show that the medical use of willow bark and other salicylate-rich plants date back to at least 3000 BC. Used to alleviate pain and reduce fever, scientists began to further study usage and the chemical compounding of aspirin in the 19th century.
From 1853 to 1893 German chemists Charles Frederic Gerhardt and Felix Hoffman, along with other chemists, made breakthroughs in synthesizing acetylsalicylic acid, a compound that was discovered 130 years earlier when it was found that the extract from willow bark reduced fever in malaria. By 1897 the German company Bayer learned how to purify the salicylic acid with acetic acid (vinegar), and patented ‘acetylsalicylic acid’ as ‘aspirin’, which over time eventually became generic, like Acetominophen and Ibuprofen.
Aspirin’s popularity grew over the first half of the twentieth century, specifically due the effectiveness when used during the Spanish flu pandemic of 1918. This led to further competition and tremendous growth of aspirin brands and products.
Chemists continued to work on the improvement of this popular medication, yet the desirability of aspirin began to wane after the development of acetaminophen in 1956 and ibuprofen in 1962. However, research work continued. Between 1960 and 1970, John Vane and other chemists discovered the basic mechanism of aspirin’s effects, and additional clinical trials and studies from the 1960s to the 1980s established aspirin’s efficacy as an anti-clotting agent. Aspirin sales revived considerably in the last five decades as it was clearly shown that aspirin is a preventive treatment for heart attacks and strokes.
The components of aspirin continue to irritate the stomach, especially in people who drink alcohol. The latest response to this side effect is the development of aspirin that is enteric coated or labeled as “safety coated.” The goal of enteric coating is to dissolve safely in the small intestine, not in the stomach. In reality, enteric coatings do not reduce the risk of significant stomach bleeding, and even have some drawbacks. For one thing, by slowing the dissolving and absorption of aspirin, enteric coatings delay pain relief by as long as three or four hours. Plus, as discussed earlier, aspirin blocks the effect of certain substances (prostaglandins and thromboxanes), so whether the aspirin dissolves in the stomach or intestine, systemically, aspirin can lead to stomach upset or worse side effects such as stomach bleeding, ulcers, and even death in a small percentage of users. The risk of stomach upset and bleeding is much smaller with low-dose aspirin, but still exists.
For the occasional headache, fever in adults (aspirin can cause Reye’s syndrome in infants and youngsters up to age 18, a potentially fatal swelling of the liver and brain) and reduction of inflammation – a dose of two non-enteric coated aspirin can be just what the doctor ordered. Next week we will examine the benefits of low-dose daily aspirin use and how to manage your lifestyle and diet to prevent side effects.
John Mamana, MD
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