What long-term risks come with taking aspirin regularly?
Regular aspirin use can lower the risk of certain cardiovascular events, but long-term use also increases the chance of serious bleeding and other gastrointestinal (GI) problems. The best-known long-term risks are:
- GI bleeding and ulcers: Aspirin can irritate the stomach lining and reduce the blood’s ability to clot, which raises the risk of ulcers and GI bleeding over time.
- Hemorrhagic stroke: Because aspirin affects clotting, it can increase the risk of bleeding in the brain, even though it can reduce clot-related strokes.
- Kidney injury in some people: Long-term NSAID-like effects (aspirin is in this class) can worsen kidney function in susceptible individuals.
Who is most likely to experience those long-term harms?
Risk is higher when aspirin is used at higher doses or combined with other medicines that increase bleeding risk. People more likely to have complications include those with:
- Prior GI ulcers or GI bleeding
- Age-related vulnerability (risk rises with older age)
- Concurrent use of other blood-thinning drugs (for example, warfarin or direct oral anticoagulants)
- Concurrent use of other medications that raise bleeding risk (including other antiplatelet agents and some anti-inflammatory drugs)
- Uncontrolled high blood pressure (a major risk factor for bleeding events, including hemorrhagic stroke)
Does low-dose aspirin have the same long-term risks as higher doses?
Low-dose aspirin has a lower bleeding risk than higher doses, but it still increases the risk of GI bleeding and other hemorrhagic complications compared with not using aspirin. Dose and duration matter: higher doses and longer use generally increase risk.
What warning signs should people watch for during long-term aspirin therapy?
Concerning symptoms can include:
- Black, tarry stools or blood in the stool
- Vomiting blood or material that looks like coffee grounds
- Unusual bruising or bleeding that takes longer than usual to stop
- Severe or worsening abdominal pain
- Sudden severe headache, weakness, numbness, or trouble speaking (possible bleeding event)
If any of these occur, urgent medical evaluation is important.
Are there long-term risks beyond bleeding (like cancer or heart effects)?
Aspirin’s effects depend on why it’s being taken. For people using aspirin for cardiovascular prevention, the long-term benefit comes from fewer clot-related events, but bleeding risks must be weighed against that benefit. For people using aspirin for other goals, risk-benefit can differ.
The overall decision is usually individualized based on bleeding risk, cardiovascular risk, age, and personal history (especially prior ulcers or prior bleeding).
How should patients weigh risks vs benefits?
For many people, aspirin is not automatically the best long-term choice. Clinicians generally consider:
- Whether the goal is primary prevention (no prior heart attack/stroke) versus secondary prevention (history of cardiovascular disease)
- A patient’s baseline bleeding risk and history of ulcers/bleeding
- Other medications that may interact
- The lowest effective dose and whether stopping later would be appropriate
If you tell me your age, the dose you take (for example, 81 mg), how long you’ve been on it, and why you started (heart/stroke history vs prevention), I can help you think through what long-term risks matter most for your situation.