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 Between 40 percent and 60 percent of over-75s in Europe and the
United States take aspirin every day, previous studies have
estimated, but the implications of long-term use in older people
have remained unclear until now because most clinical trials involve
patients under 75.
The study published on Wednesday, however, was split equally between
over-75s and younger patients, examining a total of 3,166 Britons
who had suffered a heart attack or stroke and were taking
blood-thinning medication to prevent a recurrence.
Researchers emphasized that the findings did not mean that older
patients should stop taking aspirin. Instead, they recommend broad
use of proton pump inhibitor heartburn drugs such as omeprazole,
which can cut the risk of upper gastrointestinal bleeding by 70-90
percent.
While aspirin -- invented by Bayer in 1897 and now widely available
over the counter -- is generally viewed as harmless, bleeding has
long been a recognized hazard.
Peter Rothwell, one of the study authors, said that taking
anti-platelet drugs such as aspirin prevented a fifth of recurrent
heart attacks and strokes but also led to about 3,000
excess-bleeding deaths annually in Britain alone.
The majority of these were in people aged over 75.
"In people under 75 the benefits of taking aspirin for secondary
prevention after a heart attack or stroke clearly outweigh the
relatively small risk of bleeding. These people needn't worry,"
Rothwell said.
"In the over-75s the risk of a serious bleed is higher, but the key
point is that this risk is substantially preventable by taking
proton pump inhibitors alongside aspirin."
Faculty of Pharmaceutical Medicine President Alan Boyd, who was not
involved in the study, said it had been considered that the benefits
of aspirin outweighed the risks of bleeding in all patients and that
the new research would force a reappraisal.
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Rothwell, Director of the Centre for Prevention of Stroke and
Dementia at Oxford University, and his colleagues found that the
annual rate of life-threatening or fatal bleeds was less than 0.5
percent in under-65s, rising to 1.5 percent for those aged 75-84 and
nearly 2.5 percent for over-85s.
Because the majority of patients studied were taking low-dose
aspirin, rather than more modern anti-platelet drugs such as
clopidogrel or AstraZeneca's Brilinta, the study could not draw
conclusions about combined drug use.
However, a commentary in The Lancet medical journal, where the study
was published, noted that patients on dual anti-platelet therapy
were known to have a higher risk of bleeding than those on
monotherapy and that the research showed the need for regular
evaluation of older patients.
(Editing by David Goodman)
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