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My doctor told me to take aspirin for my heart. Should I take the chewable or the coated kind?

Published: March 20, 2014 04:30 PM

Either is a reasonable choice. Our review of the research reveals no clear evidence that one formulation is better than another at preventing heart attack and stroke. Just choose the one you are likely to stick with—our medical consultants say the most important thing is to take it consistently every day.

Between 10 percent to more than 50 percent of people taking low-dose aspirin are spotty about following a daily regimen, according to a 2010 review of 32 studies involving more than 144,000 patients. Up to one-quarter just stop taking the drug against their doctor’s advice. That’s especially worrisome because abruptly stopping aspirin therapy has been shown to temporarily boost the risk of heart attack and stroke.

Coated tablets are cheap and might cause less stomach irritation. That’s because unlike typical pill coatings, the “enteric” or “safety” coating used on aspirin delays release of the drug until it’s in your small intestine. But evidence suggests that the coating doesn’t reduce the risk of the most serious side effect—internal bleeding, especially in the stomach, intestines, and, less commonly, the brain. No matter where the aspirin dissolves, once in the bloodstream it not only interferes with blood clotting but also blocks substances that protect the stomach lining.

Another potential problem with the coating is that it can interfere with some people’s ability to absorb the drug. One recent study found that while immediate-release aspirin was well-absorbed, people’s responses to the coated version varied. But because the anti-clotting effect of aspirin persists for more than just a day, minor variations in day-to-day absorption might not matter much if you adhere to taking the drug daily.

Chewable aspirin costs slightly more, but is still quite inexpensive—about $1.80 for a month’s supply of a store brand. But if you tend to forget a dose or two, it may be worth the extra cost.

Whether you need a daily aspirin or not is a decision that should be made with your doctor. Don't start to take daily aspirin on your own without your doctor’s knowledge and without first discussing the risks and benefits with him or her. While a daily low-dose (81 milligram) aspirin can help reduce the risk of heart attack and stroke in people who have been diagnosed with heart disease or who have already suffered a heart attack, stroke, or TIA (near stroke), it does have downsides. So it’s not for everyone.

Advice on the dosage, formulation, and who stands to benefit most from taking a daily aspirin could change as the U.S. Preventive Services Task Force is currently evaluating the issue with new recommendations possible by later this year. We'll keep you posted.

Whether or not you take daily aspirin, you should consider keeping the drug in your medicine cabinet in the event that you or someone close to you experiences symptoms of a possible heart attack. If that happens, call 911 and then chew and swallow 325 milligrams of aspirin (one regular-strength aspirin or four low-dose pills), which helps to prevent clots from forming and can reduce the damage a heart attack can cause. Chew the aspirin regardless of whether it was intended to be taken that way in order to get the drug into your system as quickly as possible. This simple step has been shown to save lives.

We have the answers to more aspirin questions:

I can't take aspirin. Is there an alternative?

Can I take Tylenol and a daily aspirin at the same time?

Should I take aspirin to help prevent a heart attack or stroke?

—Teresa Carr

Editor's Note:

This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

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