Daily Aspirin Linked to Increased Bleeding Risk in Seniors

A new study recommends that patients over 75 who take aspirin on a daily basis should be co-prescribed a proton-pump inhibitor (PPI) to reduce the risk of bleeding.

Researchers at the University of Oxford (United Kingdom) and John Radcliffe Hospital (Oxford, United Kingdom) conducted a prospective, population-based cohort study in 3,166 patients (50% aged 75 years and older) from the Oxford Vascular Study. All patients had suffered a first transient ischemic attack, ischemic stroke, or myocardial infarction (MI), and were treated with antiplatelet drugs (mainly aspirin based). The researchers then calculated age-specific numbers needed to treat (NNT) to prevent upper gastrointestinal (GI) bleeding, both with and without routine PPI co-prescription.

The results showed that during 13,509 patient-years of follow-up, 405 suffered bleeding events (218 gastrointestinal, 45 intracranial, and 142 other); major bleeding risk increased steeply with age, in particular for fatal bleeds. At age 75 years or older, major upper GI bleeds were mostly disabling or fatal, and outnumbered disabling or fatal intracerebral hemorrhage with an absolute risk of 9.15 per 1,000 patient-years. The estimated NNT for routine PPI use to prevent one disabling or fatal upper GI bleed over five years fell from 338 for individuals younger than 65 years, to 25 for individuals aged 85 years or older. The study was published on June 13, 2017, in The Lancet.

“We have known for some time that aspirin increases the risk of bleeding for elderly patients. 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,” said lead author Professor Peter Rothwell, MD, PhD, of the University of Oxford. “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. However, suddenly stopping medication is definitely not advised, so patients should always talk to their doctors.”

PPIs are a group of drugs whose main action is a pronounced and long-lasting reduction of gastric acid production by irreversibly blocking the hydrogen/potassium adenosine triphosphatase enzyme system (H+/K+ ATPase) of the gastric parietal cells, which is directly responsible for secreting hydrogen ions into the gastric lumen. According to various studies, PPIs can reduce upper GI bleeding by 70-90% in patients receiving long-term antiplatelet treatment.

Related Links:
University of Oxford
John Radcliffe Hospital