A common heart attack scenario may go like this:  You’ve come home from eating a large meal at a nice restaurant and now your chest is feeling heavy, sort of like something sitting on top of it.  The feeling intensifies to a vise-like grip.  Assuming its heartburn, you take an antacid but with no relief.  Now the pain is spreading to your jaw and shoulder.   Your spouse takes one look at you, mentions the words “heart attack,” calls 911 and brings you an aspirin.

Aspirin as a first line of defense

Your spouse was very wise in their actions.  The first step in responding to someone experiencing a heart attack is to call 911.  The second is to take an aspirin.

After the paramedics arrive and have loaded you into the ambulance speeding off to the hospital, in route they will give you oxygen and medication as they monitor your blood pressure and heart rhythm until you arrive at the emergency room.  But before their arrival, taking an aspirin can make a world of difference in your survival.

When a person has a heart attack, also called a myocardial infarction, it refers to the death of a section of heart muscle as a result of prolonged oxygen deprivation.  This most commonly occurs when plaque and/or a blood clot block one or more of the coronary arteries.  These are the blood vessels that supply the heart muscle with oxygenated blood. 

Plaque is a waxy fatty substance that builds up within the coronary arteries, among other blood vessels, as a result of many factors, including too much cholesterol in the blood.  Sometimes, plaques rupture (burst).  When the plaques rupture, they will attract a component of blood called platelets. Platelets are cell-like structures that mass together to form a blood clot.  This blood clot, technically is called a thrombus, grows bigger and bigger as more and more platelets and other components mass together to form it.  Eventually, the blood clot blocks off the coronary artery much like something may clog a drainpipe.  Once it is blocked off, oxygen-rich blood fails to reach a section of the heart muscle.  That section of heart muscle gasps for oxygen, suffocates, and eventually dies and this is what triggers a heart attack.     

This is where taking an aspirin can help.  Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) commonly used to relive pain.  But, aspirin may also prevent the formation of blood clots since it has antiplatelet properties. Meaning it helps to prevent platelets from sticking to one another like sticky candy might stick together.  By preventing this stickiness of platelets, a blood clot is unable to form.   By inhibiting clotting, aspirin helps reduce damage to the heart and brain helping prevent heart attack and stroke.  Only a tiny amount is needed to inhibit all the platelets in the bloodstream. But since clots can grow minute by minute, time is of the essence.  This is why it is recommended to chew and swallow an aspirin as soon as you are concerned in order to start therapy immediately even before the paramedics arrive.

Should aspirin be chewed or swallowed?

A common question people ask who have experienced a heart attack is should aspirin be chewed or swallowed.  Chewing an aspirin is what is recommended over swallowing an aspirin.

There have been several studies researching this answer and chewing an aspirin is what has been found to be the best method for reducing damage from a heart attack.   One small study conducted in Texas asked 12 volunteers to take a standard 325 mg dose of aspirin in three different ways:  by swallowing a tablet with 4 ounces of water, by chewing the tablet for 30 seconds before swallowing it, or by drinking 4 ounces of water with Alka-Seltzer.  Each volunteer tried all three methods on an empty stomach on different days.  Researchers monitored blood levels of aspirin and its active ingredient, salicylate, at frequent intervals, along with measuring thromboxane B2, an indicator of platelet activation which drops as platelets are inhibited.

Out of the three measurements, chewed aspirin worked fastest.  It required only five minutes to reduce thromboxane B2 concentrations by 50%; the Alka-Seltzer took almost 8 minutes, and the swallowed tablet took 12 minutes.  To produce maximal platelet inhibition, it took 14 minutes for the chewed aspirin, while it took Alka-Seltzer 16 minutes and the swallowed aspirin 26 minutes.

Other large randomized clinical trials have found that if aspirin is used immediately at first signs of a heart attack, the mortality rate after five weeks is reduced by 23%. 

For best results, the current recommendation for people who may be having a heart attack is to chew and swallow one non-coated adult aspirin (325 mg) as soon as possible.  Chewing or crushing the aspirin will get into your bloodstream more quickly, within four to five minutes.  And remember, always call 911 first, then your doctor.  Also discuss with your doctor their advice on taking aspirin at the first sign of a heart attack before one happens. 

It is advised to not start aspirin therapy without first consulting your doctor.  The risks and benefits of aspirin therapy vary from person to person as there can be risks associated with it.  Aspirin thins the blood and if taken daily, it can lead to gastrointestinal and intracranial bleeding. 

If a person is having a stroke, do not take an aspirin as not all strokes are caused by a blood clot.  Most strokes are caused by clots but some are caused by ruptured blood vessels.  Taking aspirin could potentially make these bleeding strokes more severe.