Health Answers

Should marathon runners take a baby aspirin before a big race?

By Judy Foreman
April 20, 2009
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Q. Should marathon runners take a baby aspirin before a big race?

A. Probably, according to emerging scientific evidence. But not all doctors agree.

Marathon running can cause muscle injury that triggers production of inflammatory chemicals called cytokines. Cytokines boost activation of blood clotting agents called platelets, potentially raising the risk of clot-induced heart attacks, says Dr. Arthur Siegel, director of internal medicine at McLean Hospital in Belmont and a volunteer in the Boston Marathon medical tent.

In 2006, Siegel and colleagues reported in the journal of the American Society for Clinical Pathology that "during a race, a runner goes from the low risk to the high risk category for having an arterial thrombus [clot in an artery]." (The study used a blood test made by Bayer HealthCare, which makes aspirin.)

"Aspirin is potentially an antidote to this platelet activity," Siegel said - thus, it makes sense for marathoners to take a baby aspirin before a race.

The idea of taking a baby aspirin - 81 milligrams - before a marathon was also strongly endorsed this month by Dr. Lewis Maharam, medical director of the New York City Marathon and author of the "Ask the Running Doc" column in "Runner's World."

In March, the US Preventive Services Task Force, an independent panel of private-sector experts convened by the government, endorsed daily use of 75 milligrams of aspirin - roughly the amount in a baby aspirin - to prevent acute cardiovascular disease in men aged 45 to 79 and to prevent stroke in women aged 50 to 79, whether they are runners or not.

Aspirin was not recommended for people at low risk for cardiovascular disease. It cautioned that the recommendations apply only when the potential reduction of stroke or heart attack risk outweighs the increased risk of gastrointestinal bleeding due to aspirin.

Some doctors remain cautious. Dr. Malissa J. Wood, a cardiologist, co-director of the women's heart program at Massachusetts General Hospital and marathon researcher, cautioned that while muscle injury can increase platelet activity, it's not clear that this translates to heart problems in runners.

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Correction: The Health Answers column in Monday's "g" section misidentified the forum in which Dr. Lewis Maharam writes about running. He authors a blog on

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