Daily Use Of Aspirin Increases Risk Of Bleeds And Death

Nick Mcbride
June 14, 2017

Long term intake of aspirin to prevent stroke or heart attack may put older adults at far greater risk of potentially deadly internal bleeding than previously thought, a new Oxford study warns.

About 3,000 deaths a year can be attributed to aspirin and other blood-thinners, Peter Rothwell, the lead author, said yesterday.

Previous studies have shown there is a clear benefit of short-term antiplatelet treatment following a heart attack or stroke.

Around 40 per cent of over-65s in the United Kingdom take aspirin in low doses to thin the blood and so prevent blood clots, which can lead to strokes or heart attacks. "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". During the study, a total of 314 patients were admitted to hospital for bleeding, with the risk increasing with age.

Compared with younger patients, older aspirin users were 10 times more likely to experience disabling or fatal gastro-intestinal bleeding.

Stopping aspirin suddenly has been shown to have a rebound effect - increasing the chance of heart attack, TIA and stroke for weeks after the pill is stopped.

Global Positioning System should prescribe proton-pump inhibitors (PPIs) to over-75s who are on a daily dose of aspirin, to prevent serious gastrointestinal bleeds, a study has concluded.

Elderly patients should not panic over reports that taking aspirin long-term increases the risk of stomach and gut bleeding, doctors said.

But with around half the people on lifelong aspirin in the United Kingdom now over 75, researchers at Oxford University chose to find out whether the benefits still outweigh the risks in this group.

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The proportion of survivors for whom a bleed resulted in a new, or sustained increase in disability rose from 3% for people aged under 75, to 25% for people aged over 75.

"You would probably be advised to stop it in your late 60s or around 70 because at that point the risk of bleeding does start to take off - the risks may well outweigh the benefits", he said. After a transient ischemic attack, ischemic stroke, or myocardial infarction, aspirin is commonly taken to prevent a recurrent event.

The study, however, could not establish that the risk is caused entirely by aspirin seeing that previous studies implied that approximately 50% of bleeds would have happened regardless of the aspirin consumption.

Experts said the blood-thinning drug causes around 20,000 major bleeds in the United Kingdom - of which a sixth are fatal.

Professor Alan Boyd, president of the Faculty of Pharmaceutical Medicine, which represents physicians, said: 'This is an important finding for two reasons; first it has highlighted a serious problem in the over-75 population treated with long-term aspirin that needs to be recognised; and secondly it provides a solution to the problem in the recommendation of taking a PPI along with the aspirin to prevent the bleeding.

He noted that the cost of treating a patient with aspirin and an inhibitor was "very small" in comparison with hospital treatment for a major bleed.

There are very well established preventative effects that the aspirin has in people who have had a major heart problem, by reducing the risk of another attack or stroke by 20%.

Prof Helen Stokes-Lampard, head of the Royal College of Global Positioning System, says: "Patients who regularly take aspirin either as prescribed by their doctor or self-medicated, should not panic as a result of this research".

Other reports by VgToday

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