Since the pharmaceutical company Bayer patented
aspirin
in 1899, doctors have prescribed this drug as an analgesic, anti-inflammatory, antipyretic (to lower fever) and antithrombotic, a type of drug that prevents the formation of thrombi that cause heart problems.
Acetylsalicylic acid was not lacking in any home for decades of the last century.
He could not do it: it silenced the laments of trauma, relieved the discomfort of muscle contractures, softened the ordeal of low back pain, relieved menstrual and joint pain ... Until it was replaced by more modern drugs, such as ibuprofen and paracetamol.
For another medicine it would have been the first step in a bitter decline, but the popularity of aspirin did not wane.
Quite the opposite.
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Scientific research on the effects of this drug has not stopped producing interesting results for problems more serious than low back pain, fever, and the occasional headache.
A possible improvement in the prognosis of covid-19 patients, according to a study from the University of Maryland School of Medicine, is the latest.
But not the best (it is more, it is a specific and small study of 400 people, whose results should be replicated in other investigations to begin to be taken into account. In no case does it justify self-medication).
It is much more interesting, mainly because there is a growing scientific consensus that numerous publications
attribute to aspirin effects as a preventive agent against cancer
.
In an American trial published in the
JAMA Network Open
magazine
a year ago, patients who used aspirin up to 3 times a week had lower mortality from different types of cancer.
A review of the scientific literature published last November in the journal
Gut
, which focuses on colorectal cancer, suggests that it exerts a significant protective effect against this disease.
And it is already normal for people who have had a heart attack or stroke, or who have undergone certain heart surgeries, take aspirin for life.
But beware: even if the drug is one of the most versatile in the medicine cabinet and its longevity can itself certify its safety, do not run to the pharmacy in search of the miracle.
No matter how much news you read, without proper medical advice and control aspirin can cause more problems than benefits.
You don't want the doctor to make you take it daily
The reason why aspirin is prescribed as prevention of
heart disease
among those who have already had an event or, for example, have a
stent
(and, by medical decision, to someone who has not had it but is at high risk) is is that the drug has an antithrombotic function.
"It works as an antiaggregant, prevents blood from clotting normally and forms occlusions of blood vessels, something convenient in people at risk of heart attack, angina or other heart problems", indicates Óscar López Moreno, member of the Office of Pharmacy of the Official College of Pharmacists of Madrid.
However, as a 2012 review of the scientific literature published in the journal
JAMA Internal Medicine
showed
, the benefits are lower than the risks among healthy adults.
The most common risk
posed by
the drug is that of internal bleeding
, which can go unnoticed and have serious consequences.
This situation happens because aspirin has a gastroerosive effect.
According to Marisa Alonso, from the Drug Use Review subcommittee of the Spanish Society of Family and Community Pharmacy, "it damages the mucosa of the stomach and
can lead to gastric ulcers
."
This is the process: acetylsalicylic acid prevents proteins called cyclooxygenases from working, “which synthesize prostaglandins, which are responsible for promoting inflammation, maintaining the integrity of the gastric mucosa and ensuring the proper functioning of the bleeding containment process .
By blocking them, aspirin works as an anti-inflammatory, analgesic and antithrombotic, but, as a side effect, it damages the gastric mucosa ”.
Another big problem with this drug was its children's version, which, according to a study by the Yale School of Medicine (USA) in 1989, seems to be related to Reye's syndrome.
This condition can lead to sudden brain damage and liver problems in your child.
That is why infant aspirin was withdrawn from the Spanish market in 2003 and is still prohibited for children under 16 years of age.
Although its anti-inflammatory and analgesic effect is similar to that of ibuprofen, the latter is prescribed more in consultations for its greater safety.
Something similar happens with paracetamol, although Alonso points out that it "has no anti-inflammatory effect."
The art is to calibrate the dose well
The key to some new uses of aspirin, so far removed from those that gave this drug its good reputation, is not only in using it daily but also in administering low doses, far from those of the tablets of up to 500mg in which it is used. presents the drug.
These amounts have even been linked to a reduction in the risk of preterm birth in new mothers, in a study published last year in
The Lancet -
curiously, more than 2,000 years ago, the Greek physician Hippocrates recommended the cortex of myrtle and willow, where the active principle of the drug comes from, as well as for pain and fever
-.
The women took 81mg daily for 36 weeks, a measure somewhat lower than what cardiologists recommend as prevention of a second cardiovascular event.
"
A low dose is the one between 75mg and 100mg
, but we usually use the latter", specifies Eva María Pereira, member of the Association of Vascular Risk and Cardiac Rehabilitation of the Spanish Society of Cardiology.
The reason that the dose is decisive is that aspirin will work as an analgesic or antithrombotic depending on how much is taken, explains the pharmacist López Moreno.
At low doses it will exert an antithrombotic effect because the protein on which it acts is very sensitive.
To achieve an analgesic and anti-inflammatory action, the load must be increased to 500mg, he points out.
And he warns: "As an analgesic, there are presentations of over-the-counter medications, but in the case of antiaggregants, their application should always be indicated by a doctor."
Among other things, because this drug can interact with other anti-inflammatory drugs, increasing the risk of bleeding, says the cardiologist.
"Stress does not cause a heart attack"
But stress, if accompanied by overweight, smoking, and lack of physical exercise, can be fatal.
Even more so in women after menopause
However, both López Moreno and Alonso assure that aspirin is safe.
“Used with head and follow-up, it is a very proven drug and from which we have a lot of clinical data.
Caution should be exercised in people with digestive problems
, as it can cause ulcers, nausea or vomiting, but a good advice is to always take it with food and, if necessary, use a gastric protector, ”explains López Moreno.
"We must always follow the advice and recommendation of the medical and pharmaceutical professional, and avoid our own decisions without knowledge and information, which can lead to serious situations," he reiterates.
Except in one case: don't hesitate for a second to take an aspirin if you think you're having a
heart attack
.
"The first thing I do when someone comes with this case, if they haven't done it in the ambulance, is to give them a high dose of aspirin," says cardiologist Eva María Pereira, also coordinator of the Cardiac Rehabilitation and Secondary Prevention Unit of the Lucus Augusti University Hospital, in Lugo.
It is a good idea because it is the platelets that are being formed by the clot that causes the heart attack, so inhibiting them helps to contain the consequences of the event.
In this case, it is clear where the cost-benefit balance is tilting.
The recommended dose, according to the cardiologist, is up to 300mg.