Somewhere in a great many Irish kitchens there is a small box of low dose aspirin, taken every morning with the tea. It was started years ago, perhaps because a doctor mentioned it at a check-up, perhaps because a neighbour swore by it. Nobody has questioned it since.
It is worth questioning. The evidence has shifted, and Irish research suggests a great many people here take a daily aspirin for a reason that no longer stands up. This is not a call to throw the box out. For one group aspirin remains genuinely protective and stopping it unsupervised would be a serious mistake. For another it is quietly doing harm. The only way to know which you are is to ask.
TL;DR
- Daily aspirin for primary prevention (in people who have never had a heart attack or stroke) is now the single most common potentially inappropriate prescription among older adults in Ireland, at almost 15% in TILDA research.
- The ASPREE trial, in over 19,000 adults aged 70 and above, found no cardiovascular benefit and a clear increase in major bleeding.
- After a heart attack, ischaemic stroke or TIA, a stent or a bypass, aspirin is still recommended. Do not stop it on your own.
- Enteric coated or “stomach friendly” aspirin does not remove the bleeding risk.
- The next step is a medicines review with your GP or pharmacist, not a decision made at the kitchen table.
Two very different situations, one identical tablet
Almost all the confusion comes from the same 75mg tablet being used for two separate purposes.
Secondary prevention means you already have established cardiovascular disease: a heart attack, an ischaemic stroke or TIA, a stent, a bypass, or peripheral arterial disease. Aspirin makes platelets less sticky and measurably reduces the chance of a second event. That benefit comfortably outweighs the bleeding risk for most people.
Primary prevention means none of that has happened and you are taking aspirin hoping to prevent a first event. This is where the ground has moved, and it has moved a long way.
What the ASPREE trial changed
ASPREE settled the argument for older adults. Just over 19,000 community-dwelling people aged 70 and above, with no history of cardiovascular disease, dementia or physical disability, took either 100mg of aspirin daily or a placebo, and were followed for a median of nearly five years.
The 2018 results were not what most doctors expected. Aspirin produced no significant reduction in cardiovascular events, but it did produce more bleeding: roughly 8.6 major haemorrhages per 1,000 person-years against 6.2 on placebo, a 38% relative increase. There was also a higher rate of death from any cause in the aspirin group, driven largely by cancer deaths, which the researchers themselves flagged as unexpected and to be treated cautiously rather than as established fact.
An extended analysis in the European Heart Journal in August 2025, following the same participants for around 8.3 years, confirmed it: still no long-term cardiovascular benefit, with major bleeding remaining elevated. Guidance followed. The influential US preventive taskforce now recommends against starting low dose aspirin for primary prevention at 60 and over.
The Irish picture is striking
Ireland has unusually good data on this. Research from The Irish Longitudinal Study on Ageing (TILDA) at Trinity College Dublin found around 21.6% of participants, mean age just under 67, reported being prescribed aspirin. Of those, 77.6% had no previous cardiovascular disease at all. Scaled nationally, that pointed to roughly 201,000 older adults in Ireland taking aspirin for primary prevention.
A more recent TILDA analysis applied the STOPP/START version 3 criteria, the prescribing safety tool developed by Professor Denis O’Mahony’s team at University College Cork and now used across Europe, to more than 3,600 community-dwelling older adults. Around 31% were on at least one potentially inappropriate medicine, and the single most prevalent problem by a wide margin was aspirin for primary prevention, at 14.78%. The next two, long-term NSAIDs and sleeping tablets, came in under 3% each. Exposure to potentially inappropriate medicines was in turn associated with more hospital admissions and greater functional decline.
The most common medicines problem facing older adults in Ireland is not an exotic drug interaction. It is a cheap tablet most people do not think of as a medicine at all.
If you have had a heart attack or stroke, this is not about you
Headlines about aspirin regularly frighten the wrong people. If yours was started after a cardiac event, a stroke, a stent or a bypass, it is doing an important job, and stopping antiplatelet treatment abruptly after a stent can be dangerous. Nothing in the recent evidence changes that. Bring the question to your GP or cardiology team instead.
Two things people commonly get wrong
“Mine is the coated kind, so it is easy on the stomach.” Enteric coating changes where the tablet dissolves, not how aspirin works. The bleeding risk comes from its effect on platelets throughout the body, so a coated tablet still carries it. Low dose aspirin is a genuine, irreversible antiplatelet drug: that is precisely why it works, and precisely why it bleeds.
“I take it as well as my blood thinner, just to be safe.” Many people on an anticoagulant for atrial fibrillation are also on aspirin with no current reason for it. Combining the two multiplies bleeding risk and often adds nothing.
How to get this looked at
- Ask at your next GP visit. If you hold a medical card or GP visit card and have a qualifying long-term condition, the HSE Chronic Disease Management Programme provides free structured reviews with your own GP and practice nurse. Medication is exactly what those visits are for.
- Ask your pharmacist. Bring everything you take, including anything bought over the counter. Aspirin is sold without prescription here, so many people start it themselves.
- Know the two questions. “Why am I on this?” and “Is the reason still true today?”
- Mind the cost. If you pay for medicines, the Drug Payment Scheme caps household spending at €80 a month.
Signs of bleeding worth acting on
Contact your GP promptly for black or tar-like stools, blood in the stool or urine, vomiting blood or material resembling coffee grounds, unusual bruising, or nosebleeds that will not settle. For a sudden severe headache, weakness on one side, or difficulty speaking, ring 112 or 999 straight away.
The honest complication
One nuance from the 2025 follow-up deserves an airing rather than burial. After the trial ended and participants came off their tablets, the former aspirin group showed a slightly higher rate of cardiovascular events, raising the possibility of a rebound effect. It is not conclusive and does not revive the case for starting. It does underline that coming off aspirin is a clinical decision in its own right, best made with a doctor who knows your history rather than after reading something online. Including this.
The takeaway
Medicines that were sensible in 2004 are not automatically sensible in 2026. Repeat prescriptions have a habit of quietly outliving the reason they were written, and aspirin is the most widespread example of it in Irish medicine presses today.
If you have never had a heart attack or a stroke and nobody has revisited your daily aspirin in years, that is a conversation worth having this month. If you have had one, keep taking it and ask anyway. At Críonna Health we cover ageing well in Ireland with the practical detail that makes advice usable, and an hour spent reviewing your medicine press costs nothing.
This article is general information and is not medical advice. Do not start or stop any medication without speaking to your GP or pharmacist.
📷 Photo by National Cancer Institute on Unsplash
