You may be hearing new discussion about when it might make sense to take more than 81mg per day of aspirin to help prevent cardiovascular events.


Lower aspirin doses usually work as well as higher doses….even after an acute coronary syndrome, stent, or ischemic stroke.  This is probably because aspirin’s antiplatelet effects are irreversible.  So even low doses achieve a full effect after several days.  Plus higher doses can double the risk of gastrointestinal bleeding.

If you are taking the new antiplatelet, “Brilinta” (ticagrelor), be sure to stick with the 81mg because higher doses of aspirin can decrease its efficacy.

The one major exception to taking 81mg is that 162 to 325mg is still recommended for the FIRST DOSE for an acute heart attack or ischemic stroke.  In these cases it is also recommended that the aspirin be chewed, retained in the mouth as long as possible, then swallowed.  Sublingual absorption of the drug can be a benefit.

We have seen some patients taking aspirin twice daily or at bedtime.  There is no evidence that this is helpful.  Stick with 81mg in the morning with food.


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