Donald Trump's aspirin remark sparks debate over the risks of daily aspirin use; top cardiologist weighs in

Donald Trump recently said that the bruise on his hand appeared more noticeable because he takes a "big aspirin" regularly. Whether or not aspirin contributed to the bruising in his case, the comment has sparked an important conversation.

Aspirin is one of the most commonly used medicines in the world, but it is also one of the most misunderstood. Just because it is available over the counter does not mean it is safe for everyone.

Why is aspirin prescribed?

Dr Sameer Bhate, Professor & Head, Cardiac Surgery & Heart Transplant, Amrita Hospital, Faridabad, explains that aspirin is much more than a painkiller.

“In cardiology, aspirin is primarily used because it prevents platelets from clumping together and forming blood clots. This significantly reduces the risk of a heart attack or stroke in people who already have cardiovascular disease or have undergone procedures such as angioplasty, bypass surgery, or valve replacement.”

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Millions of people across the world take low-dose aspirin every day after a heart attack or stroke. In India too, it is one of the most commonly prescribed medicines for patients with established cardiovascular disease. However, that does not mean everyone should start taking it as a preventive measure.

Should healthy people take aspirin every day?

“Earlier, aspirin was often recommended to prevent a first heart attack. Today, evidence has shifted our approach,” says Dr Bhate. “Research shows that in healthy individuals without diagnosed heart disease, the risk of serious bleeding may outweigh the potential benefit. Aspirin should only be started after a proper medical assessment.”

For long-term heart protection, doctors usually prescribe a low dose of 75 to 100 mg daily. Higher doses, such as 300 to 325 mg, are used only in specific medical situations and should never be taken routinely without medical advice.

What are the risks of taking aspirin daily?

One of aspirin’s biggest side effects is bleeding. Because it makes the blood less likely to clot, people may bruise more easily, bleed for longer after minor cuts, or develop stomach ulcers. In some cases, it can even lead to serious bleeding in the stomach or brain.

The risk is higher in older adults, people with uncontrolled high blood pressure, a history of ulcers, kidney or liver disease, or those already taking blood thinners.

Medicines and alcohol that can increase the risk

Dr Bhate also cautions against combining aspirin with common painkillers such as ibuprofen or diclofenac without consulting a doctor, as these medicines can interfere with aspirin’s action and further increase the risk of bleeding. Excessive alcohol intake can also make complications more likely.

What are the alternatives to aspirin?

For patients who develop gastritis or stomach ulcers with aspirin, modern cardiology now offers safer alternatives.

One widely used option is clopidogrel, an antiplatelet drug that does not irritate the stomach lining in the way aspirin can.

Clopidogrel provides comparable protection against heart attacks and strokes in patients who cannot tolerate aspirin, especially those with a history of gastrointestinal bleeding. However, it must still be used under medical supervision, as it carries its own bleeding risks and potential drug interactions.

Another important group of medicines are the newer oral anticoagulants (NOACs), such as apixaban, rivaroxaban, dabigatran and edoxaban. These drugs are not substitutes for aspirin.

They work differently and are used for specific conditions such as atrial fibrillation or the treatment of deep-vein thrombosis and pulmonary embolism. NOACs offer predictable dosing and do not require routine blood monitoring, but they can significantly increase the risk of bleeding if used without a clear medical indication. They should only be started after specialist evaluation.

The key takeaway

The key message is that aspirin is not the only option, and modern cardiology provides several alternatives.

But choosing between aspirin, clopidogrel or a NOAC depends entirely on the patient's condition, risk profile and medical history. These decisions must be made by a qualified clinician, not through self-medication.

“The biggest mistake people make is assuming aspirin is harmless because it is sold without a prescription,” Dr Bhate emphasises. “For the right patient, it is a life-saving medicine. For the wrong patient, it can cause significant harm. Never start, stop or change the dose of aspirin without speaking to your doctor.”

Aspirin has transformed modern cardiovascular care and continues to save countless lives every day. But like every powerful medicine, its benefits depend on using it wisely, not simply because it is easily available.