• Aspirin is a pain reliever that also helps prevent blood clots that can cause a heart attack or stroke.
• Due to its blood-thinning effects, aspirin may increase your bleeding risk with immune thrombocytopenia (ITP).
• Talk to your doctor to find out if it’s safe for you to take aspirin while living with ITP.

What Is Aspirin?

Aspirin belongs to a class of medications known as nonsteroidal anti-inflammatory drugs (NSAIDs). It works by blocking the effects of cyclooxygenase (COX) enzymes, which play a role in creating inflammation.

There are two forms of aspirin — prescription and nonprescription. Prescription aspirin reduces inflammation and treats symptoms of diseases like:

• Rheumatoid arthritis, a condition that causes joint pain, swelling, and tenderness
• Systemic lupus erythematosus (SLE), the most common form of lupus, that affects several organs like the kidneys, skin, and heart
• Osteoarthritis, a degenerative joint condition that causes joint pain and stiffness

Aspirin also helps in preventing and managing stroke and heart disease.

Nonprescription or over-the-counter (OTC) aspirin is available at your local grocery store or drug store. It’s used to treat a variety of symptoms, including:

• Mild to moderate pain from headaches, toothaches, and menstrual periods
• Fever
• Muscle and joint pain

Aspirin comes in many forms, including chewable, extended-release, and delayed-release tablets.

Aspirin Is Also Used To Treat Blood Clots

Blood clots use specialized cell fragments known as platelets. They stick together and form clumps along with blood cells and other proteins to stop bleeding from cuts and injuries. Although most blood clots are beneficial and help prevent blood loss, they can also create some problems.

If a blood clot becomes stuck in a blood vessel, it can block blood flow to your organs. A stroke happens when a blood clot becomes stuck in your brain, while a heart attack can happen from a blood clot in vessels supplying blood to your heart. These conditions are life-threatening if they’re not properly managed.

Aspirin has blood-thinning effects that help prevent the formation of blood clots. By blocking COX enzymes, aspirin also interferes with your platelet function and prevents aggregation (sticking together). Doctors may prescribe a daily low-dose aspirin regimen to help prevent future blood clots.

Can You Take Aspirin While Living With ITP?

ITP is an autoimmune condition that causes your immune system to make proteins known as antiplatelet antibodies. These proteins attach to your platelets and tag them for destruction. A low platelet count from ITP means your blood can’t clot as well as it should, putting you at a high bleeding risk.

Since aspirin has blood-thinning effects, it’s important to use caution when taking aspirin and other NSAIDs with ITP. It’s worth noting that aspirin won’t reduce your platelet count — it just makes it harder for platelets to stick together and form clots.

Major health organizations and hospitals like Mayo Clinic recommend taking care when using over-the-counter NSAIDs for this reason. For the most accurate information about your ITP and what medications you can take, it’s best to talk to your doctor.

Aspirin for ITP-Related Blood Clots

Interestingly, ITP is also associated with a risk of venous thrombosis, or blood clots in large veins in the body. This is because the same antibodies that destroy platelets can also activate them, making them more sticky. As a result, your platelets are more likely to grab onto blood cells and proteins, forming a clot.

When blood clots form in the deep veins in your body, it’s known as deep vein thrombosis (DVT). Most DVT clots form in the lower half of your body, like in your pelvis, calf, or thigh. If a clot breaks off and travels to your heart, lungs, or brain, you may have a heart attack, stroke, or trouble breathing.

Researchers are currently studying the use of low-dose aspirin for treating blood clots in people with ITP. Around 20 percent of people with ITP are treated with aspirin to prevent arterial thrombosis (a blood clot in an artery). As of August 2023, a phase 2 clinical trial in France is recruiting participants who take a daily aspirin regimen to treat cardiovascular disease or who have had arterial thrombosis. The clinical trial researchers hope to find that daily aspirin treatment may help reduce the risk of blood clots and protect people with ITP from arterial thrombosis.

Aspirin May Interact With Corticosteroids

Although aspirin is great for treating pain, inflammation, and blood clots, it can harm your stomach lining. It’s possible for aspirin to cause abdominal pain, nausea, vomiting, or heartburn.

Corticosteroids (steroids) are another treatment used for ITP that can help reduce inflammation and prevent your body from making antibodies. They’re highly effective at raising your platelet count and are often the first medications doctors prescribe to treat ITP. However, corticosteroids are also tough on your stomach and can cause vomiting and heartburn.

If you’re taking a corticosteroid like prednisone or dexamethasone to treat your ITP, talk to your doctor before taking aspirin. It’s best to use caution to avoid unwanted side effects.

Talk With Your Doctor About Taking Aspirin With ITP

Most major hospitals and health organizations recommend that people living with ITP avoid taking aspirin. However, everyone’s case is different. It’s best to talk with your doctor before taking aspirin or any other OTC pain relievers. They can help you weigh the benefits and the risks of taking these medications.

If you’re at risk of a blood clot or have recently had arterial thrombosis, your doctor may prescribe you an aspirin regimen. In general, aspirin isn’t recommended for people with a platelet count of less than 100,000 per microliter. However, in special circumstances — such as heart disease — a doctor may allow aspirin until a person’s platelet count drops below 50,000 platelets per microliter. Be sure to follow your doctor's instructions closely to avoid another blood clot.

When you’re shopping for OTC medications — like cold treatments, cough syrups, and antacids — be sure to read the drug labels closely. They may contain aspirin or other NSAIDs as active ingredients. Your doctor can make recommendations about which treatment options are best for you.

Acetaminophen May Be Safe To Take With ITP

Another common OTC pain reliever is acetaminophen (Tylenol). Unlike aspirin, acetaminophen isn’t an NSAID and doesn’t come with an increased risk of bleeding. It may be safer for you to take acetaminophen to treat your fever, aches, and pains. As always, be sure to talk to your doctor before taking any new medication.

Take Steps To Lower Bleeding Risk

In addition to managing your medications, you can also take extra steps to lower your bleeding risk with ITP. It’s best to stick with your treatment plan as prescribed by your doctor. This approach will help raise your platelet count. It’s also a good idea to avoid contact sports — like football or wrestling — to prevent injuries and internal bleeding.

Talk With Others Who Understand

On myITPcenter, the site for people with immune thrombocytopenia and their loved ones, people come together to gain a new understanding of ITP and share their stories with others who understand life with ITP.

Do you take aspirin while living with immune thrombocytopenia? If not, what other medications do you use instead? Share your experience in the comments below.