The following is a true-to-life scenario described by a doctor. It reflects an all-too-frequent problem.

THE whole family was worried. Now even the doctor was too. “If his bleeding doesn’t stop soon,” the doctor said, “we may have to consider a blood transfusion.”

The man had been slowly losing blood through his bowels for several weeks, and the problem had been diagnosed as inflammation of the stomach, or gastritis. “Are you sure you’re not taking any medications?” asked the frustrated doctor.

“No. Only this natural over-the-counter stuff for my arthritis,” said the man.

Suddenly the doctor pricked up his ears. “Let me see it.” Carefully searching the ingredient label, he found what he was looking for. Acetylsalicylic acid! Problem solved. When the patient stopped taking the aspirin-containing compound and was given iron and some stomach-healing medicine, the bleeding stopped and his blood count slowly returned to normal.

In 1995 the Harvard Health Letter reported that “routine aspirin use saves lives.” Citing several worldwide studies, which have been repeated many times since then, researchers concluded: “Nearly everyone who has ever had a heart attack or stroke, suffers from angina, or has undergone coronary artery bypass surgery should take one-half to one aspirin tablet daily unless they are allergic to the drug.”

With all these presumed benefits of aspirin, why doesn’t everyone take it? For one thing, there is still much that is not known. Even the ideal dosage is unclear. Recommendations range from one standard tablet twice daily to as little as one baby aspirin every other day. Should the dosage for women be different from that for men? Doctors are not sure. While enteric-coated aspirin may be considered somewhat helpful, the advantage of buffered aspirin is still controversial.

Reasons for Caution

Though technically aspirin is a natural substance—American Indians obtained components of aspirin from the bark of a willow tree—it has many side effects. Besides the fact that it causes bleeding problems in some people, there are many other potential complications with aspirin, including allergic reactions in aspirin-sensitive people. Needless to say, daily aspirin usage is not for everyone.

A person who is at risk for heart attack or stroke or who has significant risk factors, however, may want to ask his or her doctor about the risks and benefits of daily aspirin use. Certainly the patient would want to make sure he or she has no bleeding problems, no aspirin intolerance, and no stomach or gastrointestinal problems. Other potential problems or medication interactions should be reviewed with the physician prior to beginning therapy.

As noted before, aspirin and aspirinlike medications carry the significant risk of bleeding. And that bleeding may be subtle, not immediately apparent, and slowly cumulative over time. Other medications too need to be considered with care, particularly other anti-inflammatory medicines. Be sure to inform your physician if you are using any of them. In most cases it would be wise to discontinue the medication prior to surgery. Perhaps even regular laboratory monitoring of blood levels would be helpful.