General Discussion

Daily 325 mg aspirin (full-strength aspirin) taken long term is associated with several well-established risks, particularly when used for months or years. The balance of benefit versus harm depends heavily on why it is being taken and on individual risk factors.

1. Gastrointestinal (GI) effects — most common and most significant

Risk increases with duration, dose, age, and concurrent medications.

Gastritis and stomach irritation

Peptic ulcers (stomach or duodenal)

GI bleeding (may be occult or life-threatening)

Iron-deficiency anemia from chronic blood loss

Warning signs:

Black or tarry stools

Vomiting blood or coffee-ground material

Persistent stomach pain


2. Bleeding risk (systemic)

Aspirin irreversibly inhibits platelet function.

Increased risk of internal bleeding (GI, intracranial)

Easy bruising

Nosebleeds or prolonged bleeding from cuts

Increased surgical and dental bleeding risk

Intracranial hemorrhage, while uncommon, is a serious concern with long-term daily use.


3. Cardiovascular considerations

Aspirin reduces clotting, which can be beneficial in some high-risk adults

However, long-term 325 mg daily increases bleeding risk without added benefit over low-dose aspirin for most preventive indications

Modern guidelines generally discourage routine aspirin use for primary prevention unless risk is clearly elevated


4. Kidney effects (with long-term use)

More likely in dehydration, older age, or kidney disease.

Reduced kidney function

Fluid retention

Worsening of existing kidney disease


5. Hearing and neurologic effects (salicylate toxicity)

Usually dose-related, but can occur chronically:

Tinnitus (ringing in the ears)

Hearing loss (usually reversible if caught early)

Dizziness or confusion at higher blood levels


6. Asthma and allergy-related reactions

In susceptible individuals:

Aspirin-exacerbated respiratory disease (AERD)

Bronchospasm or asthma attacks

Hives or angioedema


7. Liver effects (rare but possible)

Elevated liver enzymes

Liver injury with prolonged high exposure

8. Important age-related warning (critical)

Aspirin is generally contraindicated in children and teenagers due to the risk of Reye’s syndrome, a rare but severe condition causing liver failure and brain swelling, especially during viral illnesses.

Summary risk profile

Long-term daily 325 mg aspirin is associated with:

High GI bleeding risk

Increased overall bleeding risk

Minimal added benefit over low-dose aspirin in most use cases

Not appropriate for routine use without medical supervision.