Daily Aspirin Benefits Outweigh Gastrointestinal Bleeding Risk

A new study concludes that concerns about gastrointestinal (GI) bleeding events resulting from preventive low-dose aspirin are unfounded.

Researchers at Cardiff University (United Kingdom; Cardiff University, UK) conducted a systematic review and meta-analysis of randomized controlled trials of aspirin, in which both total GI bleeding events and bleeds that eventually led to death had been reported. Principal investigators of studies in which fatal events had not been adequately described were contacted via email and asked for further details. In all, 11 trials were included in the meta-analysis.

The results revealed that the relative risk of major incident GI bleeding in patients randomized to low-dose aspirin was 1.55, and the risk of a bleed attributable to aspirin being fatal was 0.45. In all, there was no significant increase in the risk of a fatal GI bleed in patients who received prophylactic low-dose aspirin, and the substantive risk remains cerebral hemorrhage, which can be fatal or severely disabling, with an estimated risk of one death and one disabling stroke for every 1,000 people taking aspirin for ten years. The study was published on November 15, 2016, in Public Library of Science (PLOS).

“Although many people use aspirin daily to reduce the risk of health problems such as cancer and heart disease, the wider use of the drug is severely limited because of the side effect of bleeding from the stomach,” concluded lead author Professor Peter Elwood, PhD, of the Cardiff University Institute of Primary Care & Public Health. “With our study showing that there is no increased risk of death from stomach bleeding in people who take regular aspirin, we hope there will be better confidence in the drug and wider use of it by older people.”

Aspirin (acetylsalicylic acid) is a salicylate drug often used as an analgesic to relieve aches and pains, as an antipyretic to reduce fever, and as anti-inflammatory medication. Aspirin's efficacy as an anticlotting agent and its widespread use as a preventive treatment for heart attacks and strokes have turned it into one of the most widely used medications in the world. The widespread adoption of aspirin for primary cancer and vascular prevention is hampered by concerns of toxicity, in particular major GI bleeding, but unlike heart attacks, stroke, and cancer, GI bleeding is an acute event, usually followed by complete recovery.

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