Daily aspirin use may up risk of severe bleeding, death

Joy Montgomery
June 15, 2017

Around 40% of adults aged 75 or over in the United Kingdom take a daily aspirin and lifelong treatment is recommended for patients who have previously had a heart attack or stroke.

As the study was observational, it could not establish that increased risk is entirely caused by aspirin but previous research suggests about half of bleeds would have occurred whether or not people were on the drug.

Elderly patients taking daily aspirin after a stroke or heart attack should be given PPIs to reduce the risk of bleeding.

"Many people are prescribed the stomach protecting proton-pump inhibitors (PPIs) to help cut down on stomach acid and reduce irritation that can be caused by taking aspirin", says Webberley. "However, suddenly stopping medication is definitely not advised, so patients should always talk to their doctors", said Rothwell.

The study involved 3,166 patients who had previously had a stroke or heart attack, most of whom were prescribed aspirin.

Over the decade-long study, 314 patients were admitted to hospital for bleeding.

The people aged over 75 are at higher risk of stomach bleed but the risk can be prevented by taking PPIs along with aspirin.

The proportion of study participants suffering bleeds requiring hospital admission rose from 1.5% per year for those under 65 to 3.5% for those aged 75 to 84, the research showed.

If stomach-protecting PPI (proton pump inhibitor) pills are prescribed, the risk of stomach bleeds may be reduced.

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Professor Rothwell adds: "While there is some evidence that long-term PPI use might have some small risks, this study shows that the risk of bleeding without them at older ages is high, and the consequences significant".

But researchers warned yesterday the risks from taking the drug in the over-75s had been seriously underestimated - and was leading to around 3,000 preventable deaths a year.

According to the ages risk of that happening varies. While aspirin is generally regarded as safe, and the risk of bleeding is often considered minor and easily addressed, that's not the case among older people. But "major bleeding complications are a major issue in elderly patients with ischemic vascular disease treated with antiplatelet therapy".

Half were aged 75 or over at the start of the ten-year trial.

"Aspirin is an awesome little medicine that has been shown to have many potential health benefits".

The risk of disabling or fatal bleeding also increased with age. A daily aspirin dose of 75 mg is usually prescribed in both the USA and Europe to prevent heart attacks or strokes. "In other words, these new data should provide reassurance that the benefits of PPI use at older ages will outweigh the risks".

"It will continue to be necessary to make decisions of a case by case basis, considering the patient's unique circumstances and medical history, as well as the medications they are already taking and how they will interact with each other".

Heartburn medication would allows people 75 years and older to keep the preventative benefits of aspirin while avoiding its unsafe side-effects, they reported in the medical journal The Lancet. But for the older age outweighs the risk. In the United Kingdom, around 40% adults aged 75 and above consume aspirin daily.

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