CLAIM: US President Donald Trump says he takes aspirin every day, including a 386 mg dose, and has been doing so for 35 years without problems.

FACT: Daily aspirin is not appropriate or safe for everyone and should be taken only when medically indicated. While it can help prevent further cardiovascular events in people with established heart disease, its benefits for primary prevention may be outweighed by the risk of serious bleeding. Low-dose aspirin is generally around 75–100 mg, making the 386 mg dose described by Trump considerably higher than commonly used low-dose regimens. The appropriate dose depends on an individual’s cardiovascular risk, medical history and risk of bleeding.

In a widely circulating video, US President Donald Trump speaks about his habit of taking aspirin every day, saying he feels he needs it “psychologically.” Referring to Bayer Aspirin, Trump says, “I love Bayer Aspirin. I take an aspirin a day. I don’t know if it works, but psychologically, I need it.”

He then explains why he continues taking it, saying, “It thins the hell out of your blood, I guess. I don’t know if it works or not, but I’ve been doing it for a long time. And here I am, making speeches.”

Trump goes on to discuss the dose of aspirin he takes. “Bayer — and I like Bayer aspirin, the little yellow. And I take the big one. You know, they want me to go down to the 80. I take the 386. I don’t know what the hell it is. It’s a monster,” he says.

He says his doctors have advised him that he does not need the larger dose. “They said, sir, you don’t need that. I said, do me a favour. I’ve been doing okay for 35 years. Leave me alone,” Trump says.

He also describes his reluctance to switch to the smaller tablet, saying, “I’ll switch to the little tiny one. You know, it’s tiny. It doesn’t look right, you know. I’ll switch to that little tiny thing, and then something bad will happen…..”

Trump then says that he has continued taking the larger tablet despite his doctors’ advice. “No, I keep taking the big one. They say, sir, you don’t need that. You don’t need it. Thank you, doctor. I appreciate it. Then I order new — a whole brand-new stack of big ones….” 

Is it safe to consume aspirin daily?

According to the Mayo Clinic, taking aspirin every day is not appropriate for everyone. Whether it is beneficial depends on factors such as a person’s age, overall health, history of heart disease and risk of heart attack or stroke.

The Mayo Clinic explains that daily aspirin therapy is generally considered in two different situations. Secondary prevention refers to people who have already had a heart attack or stroke, or who have known cardiovascular disease. In these cases, the benefit of daily aspirin is well established. Primary prevention, on the other hand, refers to people who have not previously had a cardiovascular event but take aspirin in an attempt to prevent one. Here, the balance between benefit and harm is less straightforward.

The Mayo Clinic also cautions against starting daily aspirin without medical advice because regular use can cause serious complications, particularly bleeding. It notes that low-dose aspirin is generally around 75 to 100 mg, most commonly 81 mg, while ‘daily aspirin therapy’ may range from 75 to 325 mg, depending on the individual and the reason for treatment.

This balance between cardiovascular benefit and bleeding risk has also been examined in large clinical studies.

A 2019 systematic review and meta-analysis published in JAMA looked at 13 randomised clinical trials involving over 1.64 lakh participants without known cardiovascular disease. The researchers found that aspirin was associated with a modest reduction in cardiovascular events. The rate was 60.2 events per 10,000 person-years among people taking aspirin, compared with 65.2 per 10,000 person-years among those not taking aspirin.

However, this benefit came with an increased risk of major bleeding. Major bleeding occurred at a rate of 23.1 per 10,000 person-years with aspirin, compared with 16.4 per 10,000 person-years without aspirin.

The researchers concluded that “the use of aspirin in individuals without cardiovascular disease was associated with a lower risk of cardiovascular events and an increased risk of major bleeding.”

More recent evidence has reached a similar conclusion. A 2022 systematic review analysed 10 randomised controlled trials examining aspirin for primary prevention. The researchers found that aspirin was associated with reductions in major adverse cardiovascular events, heart attacks and ischaemic strokes. However, the treatment also increased the risk of major bleeding, intracranial haemorrhage and gastrointestinal bleeding.

The analysis found that aspirin reduced the risk of major adverse cardiovascular events by 11% and myocardial infarction by 14%. At the same time, the risk of major bleeding increased by 42%, while intracranial haemorrhage increased by 33% and gastrointestinal bleeding by 91%.

The researchers also found that the potential benefits appeared more favourable among people aged 70 years or younger who had a high cardiovascular risk and no increased risk of bleeding. However, they cautioned that the decision to use aspirin should take individual cardiovascular and bleeding risks into account.

These findings suggest that daily aspirin is not a one-size-fits-all preventive measure. It can play an important role in preventing further cardiovascular events in people with established cardiovascular disease, but for people without a previous heart attack or stroke, the decision is more nuanced because even low-dose aspirin can increase the risk of serious bleeding. Therefore, taking a higher dose does not automatically mean greater protection. The appropriate dose and whether aspirin should be taken at all depend on why it is being prescribed, a person’s cardiovascular risk, age, medical history and risk of bleeding.

What experts say

Dr B. Phalgun, Consultant – Cardiology, Aster CMI Hospital, Bangalore, said that daily aspirin is not appropriate or safe for everyone. He explained that aspirin reduces the ability of platelets to form blood clots, which can be beneficial for people who have already had a heart attack, certain types of strokes or undergone procedures such as coronary stenting.

However, for otherwise healthy people taking aspirin to prevent a first heart attack or stroke, the benefits may be small and can be outweighed by the risk of bleeding.

“Daily aspirin should therefore be started only after assessing an individual’s cardiovascular and bleeding risks,” Dr Phalgun said. He also cautioned that people who have already been prescribed aspirin should not stop taking it suddenly without discussing it with their doctor.

Addressing Trump’s claim about taking 386 mg of aspirin daily, Dr Phalgun said this is considerably higher than what is generally meant by low-dose aspirin. For cardiovascular prevention, commonly used low-dose regimens are around 75–100 mg daily, although the appropriate dose depends on the individual’s medical condition and the reason aspirin has been prescribed.

“A higher dose does not automatically provide better cardiovascular protection and may increase the likelihood of adverse effects, particularly bleeding,” he said. “A dose such as 386 mg should not be considered a routine long-term preventive dose without a specific medical indication.”

Dr Phalgun further highlighted bleeding as one of the most important concerns associated with regular aspirin use. Since aspirin interferes with platelet function, it can increase the risk of bleeding in the stomach or intestines and, in some cases, serious bleeding elsewhere in the body. Regular use can also cause stomach irritation, indigestion and ulcers.

He added that the risk can be greater with higher doses, increasing age, a previous history of ulcers or bleeding, alcohol use, and certain medicines such as anticoagulants or other antiplatelet drugs. Aspirin can also cause allergic reactions in susceptible individuals.

“The potential benefit has to be weighed against the individual’s risk of harm,” Dr Phalgun said.

According to Dr Phalgun, the decision to use aspirin should be individualised and should not be based on age alone. Doctors consider whether a person has previously had a heart attack, ischaemic stroke, coronary stent or other established cardiovascular disease, as aspirin may have an important role in preventing another cardiovascular event.

For people without established cardiovascular disease, the assessment is different and may include factors such as overall cardiovascular risk, age, blood pressure, diabetes, cholesterol, smoking status and bleeding risk.

“The key question is whether the expected cardiovascular benefit outweighs the potential harm,” he said.

Also read: Kim Kardashian has esophagitis: What is it and should you be worried? 

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