Aspirin 'major bleed' warning for over-75s

It has always been known that aspirin carries an increased risk of gastro-intestinal bleeding but the new study, published in The Lancet, suggests the danger rises far more sharply with age than was thought.

Around 40% of adults aged 75 or over in the United Kingdom take a daily aspirin and lifelong treatment is recommended for patients who have previously had a heart attack or stroke.

But the new study has shown that long-time, daily use of aspirin increases the risk of stomach bleeds, which can be fatal in some cases.

While the stomach bleeds can be potentially prevented by taking stomach-protecting PPI pills, taking daily aspirin in older people after a stroke or heart attack is still essential, and stopping aspirin use suddenly could be unsafe, according to the BBC.

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"Patients who regularly take aspirin - either as prescribed by their doctor or self-medicated - should not panic as a result of this research".

However, this advice is based on trials mostly done in patients younger than 75, the researchers point out, with a follow up of only a few years.

Researchers studied 3,166 patients who had previously had a stroke or heart attack and were taking blood-thinning drugs - mainly aspirin. The study covered a time frame of 10 years and recorded 314 study subjects who were admitted to the hospital on the account of bleeding.

This isn't the first study that's highlighted the increase risk of stomach bleeds from taking aspirin, but until now, most research involved people under 75, where the chance of serious bleeds was low.

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Current guidelines in the United Kingdom recommend people at "high risk" are given a PPI (proton pump inhibitor) drug which protects the stomach, along with aspirin therapy. The new study, published in The Lancet, also suggests the benefits of low dose aspirin after the age of 75 may be offset by increased cases of serious bleeding of the stomach and guts unless they also take PPIs. The second effect of (the) study is its support for the need to use PPIs in patients on antiplatelet therapy aged 75 years or older or in patients with a history of gastrointestinal bleeds. For the patients who are under 65, the hospital admissions due to the bleeding are 1.5 percent.

Even among those who are without any history of heart problems or stroke, risk of gastrointestinal bleeding increases with age for those using aspirin other research has revealed. Half the patients were aged 75 or over at the start of the study.

While there are some risks from long-term PPI use, they concluded that their benefits at older ages outweighed them and guidelines should recommend the co-prescription of PPIs. "As with so many things in life, it is a balance of risks versus benefits", says Webberley. Since numerous 3,000 excess deaths are preventable by taking PPIs, people over 75 should be prescribed a PPI along with their aspirin. "Therefore, any uncertainty about the small risks of PPI use are very likely to be outweighed by the benefits", said Professor Rothwell.

After a transient ischemic attack, ischemic stroke, or myocardial infarction, aspirin is commonly taken to prevent a recurrent event.

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PPIs could reduce upper gastrointestinal bleeding by 70-90% in patients receiving long-term antiplatelet treatment.

(Copyright © 2015. All Rights Reserved.)
 
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