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Low-Dose Aspirin May Lead to Bleeding in the Skull, Study Says

A new report links the practice of taking low-dose aspirin preventatively to a 37% increased risk of intracranial hemorrhage.

Maggie O'neill, Health.com, May 14, 2019

For years, many patients have been advised to take low-dose aspirin daily to protect against cardiovascular problems like heart attack and stroke. But a growing body of research has also served as a reminder that aspirin is not a cure-all-and that it also comes with its own risks.

Now, a new review of previously published studies has issued one of the strongest cautions to-date about aspirin and its potential side effects. The review, published yesterday in JAMA Neurology, suggests that taking aspirin unnecessarily may lead to bleeding in the skull.

Before you panic, keep in mind that we're not talking about people who grab the aspirin bottle every now and then when they have a headache. We're looking at people who take aspirin daily, based on the advice of a friend or neighbor who told them that regularly popping these pills can prevent heart trouble.

The authors of the new research analyzed records of 13 previous studies including 134,446 patients, and came to this conclusion: "Among people without symptomatic cardiovascular disease, use of low-dose aspirin was associated with an overall increased risk of intracranial hemorrhage." (Intracranial hemorrhage translates to bleeding in the skull.)

Specifically, heart-healthy people who regularly took low-dose aspirin were 37% more likely to experience brain bleeding, compared to those who took a placebo. The study may have especially important implications for people of Asian ethnicity and those with a BMI under 25 (considered underweight): People who fell into those categories had an especially heightened risk of these dangerous complications.

The study's authors wrote that the effects of taking low-dose aspirin are "modest but clinically relevant." Out of every 1,000 people treated with the medication and analyzed for the study, two more experienced bleeding in the skull-which, the authors point out, has been tied to a higher risk of death and disability.

Given the fact that many people have a "very low risk of atherosclerotic events," the authors wrote, "adverse outcomes from intracranial hemorrhage may outweigh the beneficial effects of low-dose aspirin" if aspirin were be to prescribed to everyone regardless of their heart-health status.

Health spoke with an expert to find out how serious this new warning is. "The average person might read this, and it seems scary," says Sarah Song, MD, a Chicago-based fellow of the American Academy of Neurology. "But remember that, as with anything you put in your body, there are pros and cons."

People who have struggled with heart trouble can still benefit from a daily low-dose aspirin, says Dr. Song. "For people who have had a heart attack or stroke and they're on aspirin, this [new warning] doesn't apply to them," she says. "It's for the people taking aspirin just to take aspirin."

The idea that aspirin can cause bleeding isn't new or surprising, but the new review serves as a good reminder, Dr. Song adds. "You should know aspirin is not harmless," she says.

If your doctor has prescribed you daily aspirin, don't stop taking it because of this report, Dr. Song says. But if you're taking aspirin based on the advice of someone else, you might want to talk to your doctor about whether or not it's necessary for you.

Additionally, if you've started taking aspirin somewhat regularly because of chronic pain, you might want to consult your physician about this. "Taking aspirin regularly for pain management is not a long-term solution," Dr. Song says. Taking ibuprofen might be a better solution, she adds, depending on the reason you need relief.

Dr. Song adds that more research is needed to learn why this problem disproportionately affects Asian populations. But the study authors point out that these findings are consistent with other research on this topic. Previous studies have suggested that Asian individuals may have a higher risk of intracerebral bleeding because of environmental or dietary factors, or because they have higher rates of smoking and high blood pressure.

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