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Daily Low-Dose Aspirin Intake Related to Major GI Bleeding Risk in Elderly

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Originally published in MDedge

In This Article

  • The ASPREE trial uncovered an increased risk of gastrointestinal (GI) bleeding in otherwise healthy older adults who took daily low-dose aspirin
  • ASPREE is the first randomized, controlled trial of the cardiovascular risk of aspirin in elderly adults over a five-year follow-up period
  • Results of the trial led to the current recommendation of not administering aspirin routinely for primary cardiovascular prevention

Daily low-dose aspirin in healthy elderly individuals increased the risk of serious gastrointestinal (GI) bleeding by 60%, a new study reveals. Previous data on aspirin-related bleeding has been largely observational and retrospective.

The new analysis from the ASPREE trial is the first to show the connection in a large, randomized, double-blind trial of over 19,000 healthy adults age 70 or older. At an average of 4.7 years of follow up, participants showed an increased risk of both upper and lower GI bleeding, which was exacerbated in individuals with additional GI bleeding risk factors. The independent risk factors identified in the study were advanced age, hypertension, obesity, smoking and chronic kidney disease.

ASPREE co-investigator Andrew T. Chan, MD, MPH, director for cancer epidemiology in the Mass General Cancer Center, chief of the Clinical and Translational Epidemiology Unit and vice chief for clinical research in the Division of Gastroenterology at Massachusetts General Hospital, commented in MDedge that this bleeding data should prove useful for clinicians to better weigh the risk and benefit of low-dose aspirin use.

The results of ASPREE and other recent trials on aspirin use pushed the American College of Cardiology/American Heart Association to eliminate aspirin's role in the primary prevention of atherosclerotic cardiovascular disease. The current recommendation among cardiologists is to not administer aspirin routinely for primary cardiovascular prevention in people over 70 years old, or in adults with increased bleeding risk.

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