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Aspirin linked to higher risk of serious bleeding in the elderly

14 Juin 2017

But the clinical tests underlying these recommendations involved mostly patients younger than 75 who had taken aspirin for only a couple years.

However, aspirin therapy is at least as likely to be as disabling or fatal as stroke in those over 75.

"Previous studies have shown there is a clear benefit of short term antiplatelet treatment following a heart attack or stroke".

The researchers suggest that taking proton pump inhibitors (PPI), a kind of heartburn medication, could reduce bleeding in the upper gastrointestinal tract by up to 90 percent.

'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.

'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'.

During this time 314 patients were admitted to hospital for internal bleeding. The proportion of survivors experiencing a new or worse disability rose from 3 per cent for those under-75 to a quarter for those older.

"These people needn't worry", Rothwell said.

"There is some evidence that long-term PPI use might have some small risks", Rothwell noted. Alternatively they need to discuss whether the advantage of taking aspirin is outweighed by the risk of internal bleeding.

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Because this was an observational study, rather than a randomised trial, it was not possible to show that the increased risk is entirely caused by aspirin, although previous research has shown it does increase the risk, the researchers added.

The vast majority of patients taking part in the study were taking low dose (75mg) aspirin, said the researchers. Only a few were being treated with a different anti-platelet drug, clopidogrel. It was not known if the findings applied to other blood-thinning drugs.

To find out more, Peter Rothwell from the University of Oxford led a team of researchers in examining medical records for more than 3,000 patients who had had a stroke or heart attack, and taken daily aspirin or its equivalent for many years.

In a linked comment published in The Lancet, German expert Professor Hans-Christoph Diener, from the University of Duisburg-Essen, wrote: "The first outcome of (this) study is that the benefit-risk association in long-term anti-platelet therapy should be evaluated every three to five years in patients older than 75 years".

"The second outcome of (the) study is its support for the need to use PPIs in patients on anti-platelet therapy aged 75 years or older or in patients with a history of gastro-intestinal bleeds".

While the drugs had "tiny benefits" for such patients in mid-life, in reducing the risk of heart disease and cancer, the dangers increase with age, he said.

Dr Tim Chico, consultant cardiologist, University of Sheffield, said the risks of aspirin were often understimated.

"You would probably be advised to stop it in your late 60s or around 70 because at that point the risk of bleeding does start to take off - the risks may well outweigh the benefits", he said.

Aspirin linked to higher risk of serious bleeding in the elderly