Dear Dr. Roach: You have written numerous articles about low-dose aspirin and its effects concerning heart problems. My doctor recommended that I take low-dose aspirin years ago, and I have been taking them since. I am 74 years old and in good physical health with no heart problems and none in my family. However, I have had a blood clot and two of my older brothers have had blood clots. Therefore, my doctors recommendation is due to the clots. You have never spoken to the efficacy of low-dose aspirin for blood clots. Please advise whether you think it is worth continuing. T.L.
Answer: There are many kinds of blood clots. A superficial blood clot in the vein causing redness and swelling in the extremity, usually the leg, is a benign condition requiring anti-inflammatory medications and raising the affected extremity. A deep venous thrombosis which is a blood clot in one of the major veins, usually the thigh or pelvis may cause swelling, and is concerning because it can break off and travel to the heart.
Deep venous thromboses usually are treated with warfarin or a newer anticoagulant like rivaroxaban (Xarelto). A blood clot that has gone to the lung is called a pulmonary embolus, and these may be life-threatening. These are also treated with powerful anticoagulants. Following a course of anticoagulants, some people may be recommended aspirin (which has effects on platelets but is less potent than warfarin and rivaroxaban) to prevent a further clot. Other people, especially those who have had several clots, or even one life-threatening clot, may be recommended for more aggressive lifelong treatment.