11:07 AM ET
Anywhere from 40% to 60% of older people take daily aspirin to prevent
a heart attack or stroke. Studies have shown that low doses of the
blood-thinner
can significantly lower the risk of heart problems, especially among
people
who have already had a heart attack or stroke.
a heart attack or stroke. Studies have shown that low doses of the
blood-thinner
can significantly lower the risk of heart problems, especially among
people
who have already had a heart attack or stroke.
But in a study published in the Lancet, researchers say that the risks of
aspirin haven’t been properly studied in older people. Most of the studies showing the over-the-counter drug’s benefits have included younger people under
65 years. However, most people who are currently taking daily aspirin
for their
heart are older.
aspirin haven’t been properly studied in older people. Most of the studies showing the over-the-counter drug’s benefits have included younger people under
65 years. However, most people who are currently taking daily aspirin
for their
heart are older.
In the study, Peter Rothwell, professor of neurology at the University of
Oxford, and his colleagues analyzed data from the Oxford Vascular Study, which followed more than 3,000 people who had had a heart attack or stroke
and were given aspirin or other anti-clotting drugs by their doctors. After 10 years, Rothwell found that ulcers and bleeding events—a common side effect
of aspirin—were more common among people over 75 than those under
65.
Oxford, and his colleagues analyzed data from the Oxford Vascular Study, which followed more than 3,000 people who had had a heart attack or stroke
and were given aspirin or other anti-clotting drugs by their doctors. After 10 years, Rothwell found that ulcers and bleeding events—a common side effect
of aspirin—were more common among people over 75 than those under
65.
Once the bleeding events occurred, most commonly in the stomach or
digestive tract, the bleeding was more intense and severe in older
people than in
younger people.
digestive tract, the bleeding was more intense and severe in older
people than in
younger people.
“The overall increased risk for older people surprised us,” says Rothwell. “And the proportion who did have major consequences from the bleeding also surprised us. We were surprised by the extent to which the bleeds were
causing disability and even death.”
causing disability and even death.”
About 1.5% of the people in the study under age 65 were admitted to the hospital for bleeding problems, compared to 3.5% for those aged 75-84
and 5% for people over age 85. The risk of having disability or even dying
after a bleeding event because of complications was 10 times higher for
those over age 75 than for younger people.
and 5% for people over age 85. The risk of having disability or even dying
after a bleeding event because of complications was 10 times higher for
those over age 75 than for younger people.
The data point to an increasing disconnect that doctors are experiencing
when they see older patients. 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. “In our clinical experience, for people in
their 80s
and 90s, bleeds can actually be devastating,” says Rothwell. “People sometimes
don’t regain their mobility, they can develop delirium, they go to the
hospital
and never regain the same level of cognitive function. There’s been an
assumption in the past that all bleeds from aspirin are like pests and
dismissed as not
a major problem, but perhaps that’s not so true in the elderly.”In fact,
says
Rothwell, for older people, the risks associated with bleeding were
actually higher
than the risk of having a heart attack or stroke, which the aspirin was
supposed to prevent.
Fortunately, there is a way to offset the risk of bleeding from aspirin: by prescribing a proton pump inhibitor, a class of drugs that reduces the
amount of acid, which can contribute to bleeding, produced by the
stomach. Studies show that they can reduce bleeding events by up to
90% in the tract. But doctors have been reluctant to add another drug
to an elderly person’s typically long list of medications, and the practice
of viewing aspirin-related bleeds as
minor also means that the risks of bleeding aren’t being addressed properly.
amount of acid, which can contribute to bleeding, produced by the
stomach. Studies show that they can reduce bleeding events by up to
90% in the tract. But doctors have been reluctant to add another drug
to an elderly person’s typically long list of medications, and the practice
of viewing aspirin-related bleeds as
minor also means that the risks of bleeding aren’t being addressed properly.
The study’s findings add more information to the growing discussion about the safety of daily aspirin. Recent studies found that older people taking low doses of aspirin every day can lower their risk of not only heart disease but
certain cancers, due to the drug’s inflammation-reducing effect. But Rothwell’s
data should encourage patients to ask their doctors about whether they
would
benefit from daily aspirin—or suffer more from side effects. The risk-
benefit
equation may be different for people who have already had a heart event, compared to those who may be at risk of having a heart attack and want
to prevent
that from happening. The American Heart Association and the U.S.
Preventive Services Task Force currently recommend daily aspirin for
people who
have not yet had heart problems, but only if they are at particularly high
risk of
having an event. The Food and Drug Administration, on the other hand,
does not recommend that people who have not yet had a heart event
ake aspirin
on a daily basis to prevent a first-time event.
certain cancers, due to the drug’s inflammation-reducing effect. But Rothwell’s
data should encourage patients to ask their doctors about whether they
would
benefit from daily aspirin—or suffer more from side effects. The risk-
benefit
equation may be different for people who have already had a heart event, compared to those who may be at risk of having a heart attack and want
to prevent
that from happening. The American Heart Association and the U.S.
Preventive Services Task Force currently recommend daily aspirin for
people who
have not yet had heart problems, but only if they are at particularly high
risk of
having an event. The Food and Drug Administration, on the other hand,
does not recommend that people who have not yet had a heart event
ake aspirin
on a daily basis to prevent a first-time event.
If you are already taking daily aspirin after a heart attack, or in an effort
to prevent your first one, Rothwell does not recommend that you stop immediately, since that can also cause a rebound effect that could be
bad for your health. But he says it might be worth discussing with your
doctor
whether adding a proton pump inhibitor would make sense to protect
you
from the potentially dangerous side effects of bleeding.
to prevent your first one, Rothwell does not recommend that you stop immediately, since that can also cause a rebound effect that could be
bad for your health. But he says it might be worth discussing with your
doctor
whether adding a proton pump inhibitor would make sense to protect
you
from the potentially dangerous side effects of bleeding.
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