The danger of daily aspirin for over-70s

A new study has found that prolonged daily aspirin use increases the risk of gastrointestinal (GI) bleeding by at least 60 per cent in people aged 70 and over.

The Monash University-led study analysed data from the ASPREE (ASPirin in Reducing Events in the Elderly) trial of 19,114 participants in Australia and the US over five years and examined whether daily low dose (100mg) aspirin was beneficial.

“Of the 264 incidents of both upper and lower GI bleeding, 162 occurred in those taking aspirin daily and 102 in the placebo group. No deaths were recorded because of a GI bleed,” the study concluded.

The international team of researchers, led by gastroenterologist and clinical epidemiologist Dr Suzanne Mahady, from the School of Public Health and Preventive Medicine, found the risk of gastrointestinal bleeding requiring hospitalisation, blood transfusions or resulting in death increased by around 60 per cent with daily aspirin use. This risk continued to increase significantly with age.

“We know that the most common side-effect of aspirin is bleeding, and that older people are at higher risk, but until now we haven’t been able to accurately quantify that risk,” Dr Mahady said.

“Now we have a much clearer picture of the additional risk of bleeding with aspirin (60 per cent) and that taking aspirin when you have additional risk factors including hypertension, a history of smoking, kidney disease or with anti-inflammatory medication could be quite dangerous.

“Prescribing doctors may now use these data to assess the bleeding risk of aspirin use among their older patients and may alternatively target the modifiable risk factors to reduce harm.”

This is the largest randomised controlled trial study to investigate bleeding in older people – with half the participants taking a placebo and the other half a daily low dose (100mg) of aspirin.

In 2019, another study, from scientists at King’s College London and King’s College Hospital, concluded that taking aspirin regularly to prevent heart attacks and strokes could lead to an almost 50 per cent increased risk of major bleeding episodes.

Lead author Dr Sean Zheng, Academic Clinical Fellow in Cardiology at King’s College London, said: “This study demonstrates that there is insufficient evidence to recommend routine aspirin use in the prevention of heart attacks, strokes and cardiovascular deaths in people without cardiovascular disease.”

In 2018, the ASPREE trial concluded “an aspirin a day did not prolong life free of disability, or significantly reduce the risk of a first heart attack or stroke among participants”.

Dr Mahady said all patients should follow the advice of their doctor about their daily use of aspirin. She cautioned that the results do not apply to those with existing conditions such as a previous heart attack, angina or stroke, where aspirin is recommended as a valuable preventive drug.

The findings relate only to healthy older people, aged 70 years and over, and do not apply to those taking aspirin on medical advice, for example those who have had a heart attack or stroke.

The Mayo Clinic advises that if you’ve had a heart attack or stroke your doctor “will likely recommend you take a daily aspirin unless you have a serious allergy or history of bleeding”.

“If you have a high risk of having a first heart attack, your doctor will likely recommend aspirin after weighing the risks and benefits.

“You shouldn’t start daily aspirin therapy on your own, however. While taking an occasional aspirin or two is safe for most adults to use for headaches, body aches or fever, daily use of aspirin can have serious side-effects, including internal bleeding.”

The US Food and Drug Administration doesn’t recommend aspirin therapy for the prevention of heart attacks in people who haven’t already had a heart attack, stroke or another cardiovascular condition.

The Australian Alcohol and Drug Foundation’s (ADF) official guidelines advise clinicians to “exercise caution” when prescribing aspirin as a preventative measure, as it can increase the risk of bleeding and damage the stomach.

“People with kidney disease, liver damage or haemophilia should consult a doctor before using aspirin.”

WebMD.com says aspirin is used to reduce fever and relieve mild to moderate pain from conditions such as muscle aches, toothaches, common cold, and headaches.

“It may also be used to reduce pain and swelling in conditions such as arthritis. It works by blocking a certain natural substance in your body to reduce pain and swelling.”

Aspirin’s serious side-effects (source: Mayo Clinic):

  • Stroke caused by a burst blood vessel. While daily aspirin can help prevent a clot-related stroke, it may increase your risk of a bleeding stroke (haemorrhagic stroke).
  • Gastrointestinal bleeding. Daily aspirin use increases your risk of developing a stomach ulcer. And, if you have a bleeding ulcer or bleeding anywhere else in your gastrointestinal tract, taking aspirin will cause it to bleed more, perhaps to a life-threatening extent.
  • Allergic reaction. If you’re allergic to aspirin, taking any amount of aspirin can trigger a serious allergic reaction.

If you’re taking aspirin and need a surgical procedure or dental work, be sure to tell the surgeon or dentist that you take daily aspirin and how much. Otherwise you risk excessive bleeding during surgery. However, don’t stop taking aspirin without talking to your doctor.

People who regularly take aspirin and drink alcoholcan have an increased risk of stomach bleeding. Talk to your doctor about how much alcohol is safe to drink. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.

Aspirin’s possible long-term effects (source ADF)

  • anaemia (low red blood cell count)
  • easy bruising and abnormal bleeding
  • inflamed stomach lining, stomach bleeding and peptic ulcers
  • vomiting blood that may look like coffee grounds and bowel motions that look like black tar
  • allergic-type reaction, wheezy breathing, and a tightness in the chest in adults, hives in children, and in some rare cases swelling of the face, lips, tongue or around the eyes
  • reduced kidney and liver function.

Aspirin: common side-effects (source ADF)

  • dizziness, ringing in the ears, blurred vision
  • drowsiness, fatigue, depression
  • thirst, sweating, fluid retention, swollen ankles
  • abdominal discomfort or bloating
  • nausea, heartburn, diarrhoea, constipation.

Using aspirin with other drugs (source ADF)

  • Aspirin plus alcohol: can increase the risk of stomach irritation and discomfort.
  • Aspirin plus warfarin or some blood pressure medicines may increase the risk of bleeding.

How often do you use aspirin?

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Related articles:
https://www.yourlifechoices.com.au/health/your-health/poor-sleep-linked-to-heart-disease
https://www.yourlifechoices.com.au/health/covid19/better-health-at-your-fingertips
https://www.yourlifechoices.com.au/health/your-health/eye-test-to-detect-alzheimers

Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.

Written by Will Brodie

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