Daily aspirin for primary prevention increased risk for major GI bleeding in healthy older adults

Area of Science:

• Geriatric Medicine
• Gastroenterology
• Clinical Trials

Background:

• Aspirin is widely used for primary and secondary cardiovascular prevention.
• Gastrointestinal (GI) bleeding is a significant adverse event, particularly in older populations.
• The ASPREE trial provided a unique dataset to investigate aspirin's risks in healthy older adults.

Purpose of the Study:

• To determine the incidence of major GI bleeding in older persons randomized to aspirin versus placebo.
• To identify risk factors associated with major GI bleeding in this population.
• To inform clinical practice regarding aspirin use in the elderly.

Main Methods:

• Analysis of data from the ASPREE (Aspirin in Reducing Events in the Elderly) randomized controlled trial.
• Inclusion of participants aged 70 years or older without established cardiovascular disease or dementia.
• Prospective collection and adjudication of major GI bleeding events.

Main Results:

• The incidence of major GI bleeding was higher in the aspirin group compared to the placebo group.
• Specific risk factors for major GI bleeding were identified, including a history of peptic ulcer disease and concomitant use of certain medications.
• Older age and male sex were also associated with increased bleeding risk.

Conclusions:

• Low-dose aspirin therapy is associated with an increased risk of major GI bleeding in healthy older adults.
• Risk stratification using factors like prior GI history and medication use can help identify individuals at higher risk.
• These findings necessitate careful consideration of the benefits and risks of aspirin use in the elderly.