Aspirin and gastrointestinal bleeding risk in older people

Area of Science:

• Gastroenterology
• Geriatrics
• Clinical Pharmacology

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 (Aspirin to Prevent Stroke, Dementia and Death) trial provided a unique dataset to investigate aspirin's effects in healthy older adults.

Purpose of the Study:

• To determine the incidence of major gastrointestinal bleeding in older persons using aspirin.
• To identify risk factors associated with major GI bleeding in this demographic.
• To analyze these outcomes within the context of the ASPREE randomized controlled trial.

Main Methods:

• Analysis of data from the ASPREE randomized controlled trial.
• Inclusion of participants aged 70 years or older without established cardiovascular disease or dementia.
• Systematic recording and adjudication of major gastrointestinal bleeding events.

Main Results:

• The incidence of major GI bleeding was observed to be higher than previously reported in similar populations.
• Specific demographic and clinical factors were identified as significant predictors of GI bleeding risk.
• The study quantified the absolute and relative risks associated with aspirin use in this age group.

Conclusions:

• Low-dose aspirin use in healthy older adults is associated with a notable risk of major gastrointestinal bleeding.
• Identification of risk factors allows for better patient selection and risk stratification.
• Findings underscore the importance of balancing aspirin's benefits against its gastrointestinal risks in the elderly.