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Dear Dr. Roach: You have written numerous articles about low-dose aspirin and its effects concerning heart problems. My doctor recommended that I take low-dose aspirin years ago, and I have been taking them since. I am 74 years old and in good physical health with no heart problems and none in my family. However, I have had a blood clot and two of my older brothers have had blood clots. Therefore, my doctor's recommendation is due to the clots. You have never spoken to the efficacy of low-dose aspirin for blood clots. Please advise whether you think it is worth continuing.

-- T.L.

A: There are many kinds of blood clots. A superficial blood clot in the vein causing redness and swelling in the extremity, usually the leg, is a benign condition requiring anti-inflammatory medications and raising the affected extremity. A deep venous thrombosis -- which is a blood clot in one of the major veins, usually the thigh or pelvis -- may cause swelling, and is concerning because it can break off and travel to the heart.

Deep venous thromboses usually are treated with warfarin or a newer anticoagulant like rivaroxaban (Xarelto). A blood clot that has gone to the lung is called a pulmonary embolus, and these may be life-threatening. These are also treated with powerful anticoagulants. Following a course of anticoagulants, some people may be recommended aspirin (which has effects on platelets but is less potent than warfarin and rivaroxaban) to prevent a further clot. Other people, especially those who have had several clots, or even one life-threatening clot, may be recommended for more aggressive lifelong treatment.

I don't have enough information about your clot history to comment on the appropriate long-term treatment. Aspirin may be the right thing for you, but your doctor is in a better position than I am to advise.

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