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Current study Life threatening bleeding risk with long-term aspirin intake
Aspirin (active ingredient acetylsalicylic acid) is one of the most commonly used drugs worldwide. Originally used primarily as a painkiller, aspirin is now also used for after-stroke after a stroke or heart attack because of its anticoagulant effect. However, taking aspirin over the long term may increase the risk of life-threatening bleeding, according to a recent study. Patients over the age of 75 are therefore more likely to experience so-called gastrointestinal bleeding on regular aspirin use.
Low-dose aspirin is often used to prevent strokes and heart attacks, as the active ingredient acetylsalicylic acid inhibits blood clotting. Especially in the elderly, however, this can be associated with a significantly increased risk of life-threatening internal bleeding, scientists from Oxford University report on their current study results. The study results were published in the renowned trade magazine "The Lancet".
The long-term use of aspirin in elderly patients leads to a significantly increased risk of life-threatening internal bleeding. (Image: Africa Studio / fotolia.com) Aspirin commonly used for heart attack and stroke prevention
In the US and Europe, around 40 to 60 percent of adults aged 75 or older take aspirin or other antiplatelet medications daily to prevent heart attacks or strokes, Oxford University reports. The lifelong treatment with antiplatelet medications is recommended (so-called secondary prevention) for patients who previously had a heart attack or stroke. However, the drugs also show unpleasant side effects. These include, among other things, the increased risk of gastrointestinal bleeding.
Risk of gastrointestinal bleeding in elderly patients remains unclear
Previous studies have already shown that there is a causal link between antiplatelet treatment and upper gastrointestinal bleeding, the researchers report. Although it is known that this risk increases with age, the estimates of the actual size of the risk have varied widely so far. To what extent the severity of the bleeding increases in patients over the age of 75 years, the researchers have now examined in a comprehensive cohort study.
Nearly 3,200 subjects studied
In total, 3 166 patients who had previously had a stroke or heart attack and then received antiplatelet medication (usually aspirin) over a ten-year period were observed in the current study. "Half of the patients were 75 years or older at baseline," the researchers report. During the study period, 314 patients were hospitalized for bleeding and the risk of fatal bleeding increased significantly with age.
Rising risk of bleeding in old age
The researchers found that patients under the age of 65 who received aspirin on a daily basis had an annual probability of about 1.5 percent for hospital treatment for bleeding. "For patients between the ages of 75 and 84, the annual incidence rate increased to about 3.5 percent," the researchers report. In patients over the age of 85, she has reached a full 5 percent. At the same time, the risk of fatal gastrointestinal bleeding increases with age. While the odds were still 0.5 percent a year for patients aged up to 65 years, the rate rose to around 1.5 percent between the ages of 75 and 84 and nearly 2.5 percent in patients over the age of 85 , the scientists report.
Balance risk and benefit
"We have known for some time that aspirin increases the risk of bleeding for elderly patients. But our new study gives us a much clearer understanding of the magnitude of the increased risk and the severity and consequences of the bleeding, "emphasizes Professor Peter Rothwell, senior author at Oxford University. Although a clear advantage of short-term antiplatelet treatment following a heart attack or stroke has been demonstrated in previous studies. However, given the current findings, questions about the risk-benefit ratio of long-term daily aspirin use at the age of 75 years or more.
Proton pump inhibitors lower the risk
The scientists also found that prescribing so-called proton pump inhibitors (PPIs) counteracts the risk of gastrointestinal bleeding. By taking PPIs, the risk of upper gastrointestinal bleeding was reduced by 70 to 90 percent in patients who received long-term antiplatelet treatment, the researchers report. Although the PPI intake brings the risk of side effects, but according to the statement of the scientists in relation to the imminent gastrointestinal bleeding, these are rather moderate.
Also PPI with side effects
"While there is some evidence that PPIs may have long-term risks, the current study shows that" the risk of bleeding without them is high in older age groups and the consequences are significant, "said Professor Rothwell. An application of the PPI to reduce the risk of internal bleeding in the elderly seems therefore worth considering, considering the benefit-risk assessment.
Consequences for the practice
Commenting on the current study, Professor Hans-Christoph Diener of the University of Duisburg-Essen emphasizes that, given the new findings, the benefit-risk ratio of long-term antiplatelet therapy is reevaluated every 3 to 5 years in patients over the age of 75 years should be. In addition, the concomitant treatment with PPI in patients with antiplatelet therapy over the age of 75 years and an earlier history of gastrointestinal bleeding should be reconsidered. (Fp)