A bleed from the stomach is a crisis! Nevertheless, the evidence from a number of studies of aspirin gives some reassurance about the seriousness of the stomach bleeds caused by aspirin. [6]
First: The risk reduces over time, and after about three years of aspirin taking the evidence from trials suggests that taking aspirin poses little additional risk of a bleed.[5, 6]
Second: The likelihood of a stomach bleed is increased greatly if the stomach is diseased, that is, if there is already a stomach ulcer, or an infection of the stomach.[2] Before taking aspirin, people who have, or have had stomach trouble, and those with frequent indigestion should seek advice about whether or not they should take aspirin at all, or whether they should take a stomach protecting drug along with the aspirin. These protecting drugs can markedly reduce the risk of a stomach bleed.[7-8]
Third: The stomach bleeds caused by aspirin appear not to be as serious as spontaneous bleeds in patients not taking aspirin (9). Therefore, although a spontaneous stomach bleed occasionally leads to death, there appears to be no valid evidence that bleeds attributable to low-dose aspirin are ever fatal. Relevant evidence comes from careful overviews of trials involving tens of thousands of subjects. [see references 10-16].
Fourth: The stomach bleeds caused by aspirin are nothing as serious as the disease events prevented by aspirin – heart attacks and cancers. A numb er of very careful studies have examined this balance between the risks and the benefits of aspirin and have concluded that low-dose daily aspirin (70-100 mg daily) is highly beneficial and increases disease-free survival (17-22)

All the above was about stomach bleeds. Bleeding into the brain, causing a haemorrhagic stroke is rare, but much more serious, leading to a disabling and life-threatening stroke. Each year one or perhaps two people in every ten-thousand (10,000) people who are not taking aspirin have a cerebral bleed and experience a haemorrhagic stroke.[23] In people taking aspirin, an addition one person in every 10,000 taking aspirin may experience a haemorrhagic stroke.[23]

Raised blood pressure is a major factor in brain haemorrhage and the risk of a haemorrhagic stroke is more than doubled if there is a modest rise in blood pressure (a 20mmHg rise in systolic pressure – see reference 10). Blood pressure should therefore always be checked and if it is raised it must be treated before aspirin taking commences.

A large trial of aspirin has given some reassurance about aspirin and these cerebral bleeds. The trial was conducted in almost 20,000 patients all of whom had raised blood pressure and all of whom were receiving ‘optimal’ treatment for their hypertension. Over the next few years there was no evidence of any excess in the number of haemorrhage strokes in patients taking aspirin – 19 patients on aspirin experienced a stroke, while 20 who received no aspirin had a haemorrhagic stroke.[24].

Finally: If a bleed does occur in a person taking aspirin, the natural response is to stop taking the aspirin. The decision to stop should however be taken cautiously. Suddenly stopping aspirin risks a rebound in vascular risk, and an increase in the risk of death (25). If it is decided to stop the drug it should be withdrawn slowly, and in fact, there is evidence that even if a bleed does occur, aspirin is best continued together with a stomach protecting drug.[26]

It is most important that the balance between the benefits of a drug and the risks from that drug is carefully evaluated, and it is most important that the evaluation is not just in terms of the numbers of people who benefit and the number who are harmed by the aspirin. The ‘harms’ (bleeding) are not nearly as serious as the ‘benefits’ (reductions in vascular disease and cancer)! A number of studies have examined the balance between these and have found the balance to be highly favourable for aspirin taking by people aged about 50 and over. [17-22].

In Conclusion: : The protection of your health, and the prevention of disease, is ultimately your own responsibility and this website has been prepared to help you take an informed decision about the protection of your own health.!