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Q. I've been on daily baby aspirin for 45 years after a heart scan spotted small amounts of calcium. So far, I've been healthy, but I have two big questions. Does the risk of bleeding diminish with long-term aspirin use?
Also, is there a dangerous rebound effect if long-term aspirin use is stopped? Two doctors I've asked said no, but I've read articles saying the chance of stroke or heart attack is significant if you discontinue aspirin suddenly. A lot of us are in limbo and would love answers to these questions.
A. You have asked crucial questions that are rarely addressed. As far as we can tell, the risk of bleeding from aspirin does not disappear over time. One large study, the ASPREE trial, evaluated the risk of digestive tract bleeding in more than 19,000 volunteers (Gut, Aug. 3, 2020).
The authors reported that people taking aspirin for about five years were 60% more likely to experience a GI bleed. But before anyone overreacts to that seemingly big number, let's look at the absolute risk. Out of 9,525 people taking aspirin, 162 had a bleed. That's an absolute risk of 1.7%.
In the 9,589-person group on placebo, 102 people had a bleed, a risk of 1.1%. That means six additional people out of 1,000 taking aspirin had a GI bleed. It is a statistically significant difference, and the graph of bleeding events over time shows that the risk of bleeding increases as people age.
Do people who suddenly stop aspirin experience blood clots? A large Swedish study found that people who stopped their low-dose aspirin abruptly were in fact more likely to experience a heart attack, stroke or other cardiovascular complication (Circulation, Sept. 26, 2017).
This poses a thorny dilemma for aspirin users like you. We could not find guidelines for tapering off aspirin gradually. Please discuss this complex topic with your physician.
Q. A doctor prescribed Farxiga to treat my Type 2 diabetes. Within a few weeks, I developed the worst vaginal itch I have ever experienced.
At first, I couldn't figure out why. However, whenever I see a TV ad for a drug I am taking, my ears perk up. If I am on that drug, I listen intently and read the "mouse print" at the end about side effects. (It helps to have recorded a program so I can push "pause" and replay while I read.)
The light bulb went off immediately when I saw the ad for Farxiga. I ditched it and the itching stopped immediately. I wrote a note to the doctor and said so.
Never ignore the lightning-speed voice-overs and teeny-tiny print about possible side effects. Doctor or not — NOBODY cares more about my health than I do.
A. Farxiga (dapagliflozin) commercials do mention side effects such as urinary tract or genital yeast infections. They also describe "a rare life-threatening bacterial infection in the skin of the perineum." That is the area between the anus and the genitals.
There are many other options for controlling blood sugar in Type 2 diabetes. You can learn about drugs such as metformin, empagliflozin (Jardiance), glipizide, and GLP-1 agonists such as liraglutide (Victoza) and semaglutide (Ozempic) in our "eGuide to Preventing & Treating Diabetes." This online guide is available under the Health eGuides tab at www.PeoplesPharmacy.com.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 300 W. 57th Street, 41st Floor, New York, NY 10019, or email them via their website: www.PeoplesPharmacy.com. Their newest book is "Top Screwups Doctors Make and How to Avoid Them."