An aspirin a day raises fatal bleeding risk for over-75s – study

An aspirin a day raises fatal bleeding risk for over-75s – study
People over the age of 75 who rely on long-term daily aspirin use are at a greater risk of dying from major bleeding than previously thought, according to a new study.

The study, published in The Lancet, found that 40-60 percent of adults aged 75 or over in Europe and the US take aspirin to prevent heart attack or stroke as it is highly recommended as a secondary prevention for those who have previously suffered a heart incident.

We have known for some time that aspirin increases the risk of bleeding for elderly patients. But our new study gives us a much clearer understanding of the size of the increased risk and of the severity and consequences of bleeds,” said Professor Peter Rothwell, the study’s lead author.

While the researchers insist on the benefits of short-term aspirin use following a stroke or heart attack, patients over 75 are now encouraged to also take a prescribed heartburn medication, known as a proton-pump inhibitor (PPI), to reduce their risk of fatal bleeding.

Our findings raise questions about the balance of risk and benefit of long-term daily aspirin use in people aged 75 or over if a proton-pump inhibitor is not co-prescribed. However, suddenly stopping medication is definitely not advised, so patients should always talk to their doctors,” said Rothwell.

The advice is based on research collected from a 10-year study of 3,166 patients, half of which were 75 or over when the study began. The patients were selected on the basis that they had a stroke or heart attack and had antiplatelet drugs, mostly aspirin, prescribed.  

Over the decade-long study, 314 patients were admitted to hospital for bleeding. The study found the risk of fatal or disabling bleeding only increased with age and the outcome worsened for older patients who suffered non-fatal bleeds.

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For example, the annual rate of patients taking daily aspirin and requiring hospitalization for bleeding was 1.5 per cent for those under 65, 3.5 per cent for those aged between 75 and 84, and 5 per cent for patients over 85.

Professor Rothwell recommends patients taking long-term daily antiplatelet therapy are also prescribed a PPI to reduce the risk of upper gastrointestinal bleeding by 70-90 per cent.

While there is some evidence that PPIs might have some small long-term risks, this study shows that the risk of bleeding without them at older ages is high, and the consequences significant,” said Rothwell.