Regular intake of Aspirin in elderly could mean higher than previously thought risk of bleeding says new study

By Dr. Ananya Mandal, MDJun 14 2017

New research shows that the use the antiplatelet drug Aspirin over long term among elderly is fraught with more risks than earlier believed.

According to the new study published in the journal The Lancet, persons over the age of 75 years who are on Aspirin regularly, are at a greater risk of serious and life threatening bleeding. At present 40 to 60% of adults aged over 75 years in the United States as well as Europe take aspirin or other antiplatelet drugs, popularly called “blood thinners”, daily in order to prevent heart attack or stroke. Those with a previous heart attack or stroke have been thought to benefit from regularly taking these antiplatelet drugs. This is called secondary prevention of future attacks. But these benefits come from studies among adults less than 75 years of age. This study is the first to look at those over 75.

According to the lead author of the study, Professor Peter Rothwell of the University of Oxford in the U.K., this risk of bleeding with Aspirin use is a known one. But this study shows a clearer picture of the extent of the risk as well as the severity of what might be the outcome of such bleeds.

For the Oxford Vascular Study, 3,166 patients in the U.K. who have had a stroke or a heart attack previously were followed up. They had all been prescribed antiplatelet drugs including Aspirin. Nearly half of the patients at the start of the study were over 75 years of age. Over the 10 years of the study 314 patients needed hospitalization for bleeding.

Results of the study showed that patients below the age of 65 had 1.5% hospitalization rates for bleeding. This rose to 3.5% among patients aged 75 to 84 and to 5% among those who were over 85 years of age. Thus the rates of severe bleeding increased with age. Annual life threatening or lethal bleeding rates were less than 0.5% for those below 65 years of age. This rose to 1.5% and 2.5% among adults aged 75-84 and over 85 years of age respectively.

Thus, when comparing, it was seen that those over 75 had a 2.6-fold increased risk of major non-fatal bleeding and a 5.5-fold increased risk of fatal bleeding episodes. The risk of major gastrointestinal bleeds was four fold among those over 75. And 62% of these major bleeds among the older patients was disabling or fatal. This also negates the earlier belief that the upper gastrointestinal bleeds are not serious.

This said, the stopping of Aspirin or other platelet drugs, is also not the solution since it raises the risk of several heart complications. Proton-pump inhibitors (PPIs) or drugs used for reducing gastric acids (used in heart burn or peptic ulcers) could be of use if they were prescribed along with Aspirin say researchers. These agents may reduce the risk of upper gastrointestinal bleeding by 70 to 90% they added. Long term use of PPIs too come with other risks but according to Rothwell, their use may reduce the risk of fatal bleeds and thus the outcome with combining use of Aspirin and PPIs is significant in reducing this risk. He summed up that use of PPIs along with Aspirin “at older ages will outweigh the risks”.