The People's Perspective on Medicine

Bleeding Ulcers from Aspirin Can Be Life Threatening

Many people take aspirin for granted. They recognize it can cause stomach upset, but they may not take bleeding ulcers from aspirin seriously. They must!
A aspirin bottle open and aspirins spilled out on black background.

We are big fans of aspirin. We think it is a drug that doesn’t get the respect it deserves, partly because it is available without a prescription and partly because it is so inexpensive. That said, many people develop bleeding ulcers from aspirin. When that happens it is a medical emergency, as this reader describes.

Sudden Onset of Bleeding Ulcers:

Q. For most of my life I took aspirin with no ill effects. A few years ago, I felt extremely weak and my heart was pounding. I went to the emergency room and was admitted to the hospital.

As it turned out, I had severe stomach bleeding due to aspirin and needed two blood transfusions. I was sent home with instructions to never take aspirin in any form whatsoever.

Watch out for Stomach Ulcers After Aspirin

A. Bleeding ulcers can be life threatening. There may be no warning symptoms prior to a full-blown emergency. A dear friend of ours, who just happens to be a physician, woke up on the morning of his daughter’s birthday feeling extremel;y weak. He could barely get out of bed.

His wife took one look at his gray face and rushed him the emergency department despite his protests. He wanted to celebrate his daughter’s birthday. Fortunately, his very smart wife probably saved his life. The bleeding ulcer he had developed because of aspirin also required blood transfusions.

Why are Bleeding Ulcers from Aspirin So Dangerous?

Because bleeding or perforated ulcers can sneak up on people, there may not be an early warning of danger. Older people may be especially vulnerable to this serious side effect.

Sometimes people may not even realize they are taking aspirin. Here is a link to a story about a women who was taking Excedrin Migraine:

Aspirin and Ulcers: A Potentially Deadly Reaction
You’ve heard of Excedrin, right? Do you know what’s in it? Aspirin, acetaminophen and caffeine. Be alert for aspirin and ulcers. Hemorrhage is a risk”

This article will alert you to the symptoms of a stomach ulcer. It will also explain why aspirin can cause bleeding ulcers.

Not Just Aspirin – NSAIDs Can Also Cause Bleeding Ulcers!

Many people realize that aspirin is a double-edged sword. It has many important benefits. Research has shown that aspirin has anti-cancer activity. See this link for details:

The Resurrection of Aspirin as an Anticancer and Pregnancy Drug
We used to say that aspirin was the Rodney Dangerfield of drugs…it didn’t get much respect. New evidence suggests aspirin as an anticancer agent should

But aspirin can be irritating to the stomach. So can all NSAIDs (nonsteroidal anti-inflammatory drugs). Ibuprofen and naproxen can also irritate the lining of the digestive tract and cause bleeding ulcers. Even though they are available over the counter, these drugs demand respect and vigilance.

Share your own experience with aspirin, ibuprofen, naproxen or other NSAIDs such as celecoxib, diclofenac or meloxicam in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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A heart doctor recommended about 10 years ago that I take a baby aspirin each day even though my heart appeared to be fine. Five years later I was on a plane flying from Atlanta to Houston after working all day. I passed out on the plane in-flight, twice throwing up blood. On arriving in Houston, I was rushed to the Emergency Room where I was diagnosed with a bleeding ulcer requiring multiple transfusions.

I am the person whose comment led this article. When the doctors told me not to take aspirin in any form, that meant baby aspirin, enteric coated aspirin, and even Aspercreme which is prescribed for arthritis. Aspercreme does contain a warning not to use it if you have experienced stomach bleeding. The reason is that the aspirin does enter the bloodstream and thins the blood making one more prone to bleeding.

This article was incomplete to the point of being somewhat misleading. At what dosages, and at what frequency of use, might aspirin pose a real risk for bleeding gastric ulcers? Mention should also have been made about any mitigating effects of using enteric coated aspirin.

The problem is that people are so variable. Some will develop problems on low-dose aspirin, while others can take a regular dose for years without difficulty.
Enteric-coated aspirin protects the stomach, but exposes the small intestine to aspirin-related irritation.
We wish we could be more definitive about exactly who is at risk at which dose.

Thank you for mentioning enteric coated aspirin. Many times these articles never mention it. Also it is never stated if the benefits are the same if you take this form. Aspirin has been mentioned as good for the colon as far as cancer is concerned.. again it is never mentioned if the enteric version is also helpful. I read the other day that people over 70 should not take aspirin for heart. I was put on it at 65, just because I was at that age, no heart issues, now at 84.. no doctor has told me to go off of it.I am actually a little paranoid to stop.

Does chewable low dose aspirin do the same thing?

It is less likely to be irritating, but it is not completely safe.

I took diclofenac orally for 20+ years for osteoarthritis in my knees. I was also prescribed a PPI to “protect my stomach.” About a year ago I went to bed on a Friday night and woke up 3 days later in the hospital. I was told I was in septic shock and completely unresponsive when the paramedics were called. I spent 12 days in the hospital, but the only issue the doctors found was a bleeding ulcer. I no longer take any NSAID orally, but use diclofenac cream on my knees. I plan to try Hyaluronic acid joint injections next month.

I have been taking a baby aspirin daily for years.
I have a fib & I take it to prevent blood clots.
The one thing everyone that takes aspirin should adhere to, never take it on an empty stomach & drink plenty of water. That was never mentioned in the article.

At the advice of my doctor, I was taking a baby aspirin every day for 6-7 years. Little did I know what it was doing to my body. I started vomiting a black substance and kept passing out. I was taken to the emergency room and immediately transported by ambulance to the hospital. It was discovered that my hemoglobin was 6 instead of the normal 12-13 and I had a bleeding ulcer that was causing internal bleeding. The black substance was actually blood which I didn’t know. After 4 units of blood and 4 days hospitalization, I was released with instructions never to take aspirin in any form again.

I took aspirin my whole life, and I loved it. Six years ago, I had stomach bleeding for a reason unrelated to aspirin… I had an AVM in my stomach. That situation got fixed, and all was well. Until I took aspirin some months later for my knee pain. Back to the hospital for another endoscopy fix. The doc said this bleed was definitely caused by aspirin. He offered to prescribe me a PPI so I could take aspirin. I declined. I’m controlling my knee pain without NSAIDS and PPIs. Everything has been fine since then.

I take coated aspirin occasionally for joint pain. I can’t take Aleve or Motrin because of an A-Fib problem. I take it with milk or food. Is there anything else I can do to make it safer?

I have taken a daily low dose aspirin since 2007 when I was diagnosed with Barrett’s Esophagus (along with omeprazole for GERD). I also have take Celecoxib for years for RA-like arthritis and other musculoskeletal issues. Knock wood, I’ve never had issues from this, and hopefully will not, because I consider both of them essential.

FYI: I’ve also had chronic low blood sodium levels for years, and recently discovered that these and other NSAIDS contribute to this condition.

What are we to do if we are told to take baby aspirin daily in order to avoid a second stroke? I had a TIA and now am mandated to take baby aspirin daily. Do you have any suggestions on how to mitigate the effects of aspirin in order to avoid the potential for the ulcers you mention? The only advice I was given is to take it with a meal. Please, please advise further.

Some advice on the safest way to take them would be useful.

If you have ulcers you take the triple medicine combination: Metronidazole, clarithromycin and operamazol. Cure the ulcers.
There are several other combinations of the drug that work too to get rid of helicobacter pylori. Also check your partners or those you kiss for helicobacter pylori, and treat them as well or in two weeks you will be infected again.The treatments are about 90% good the first time but you may need a second dose. Also make sure you change your tooth brush.

That is very good advice for spontaneous ulcers (caused by H. pylori), but it won’t make much difference so far as we know for aspirin-induced ulcers.

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