Daily aspirin behind more than 3000 deaths a year, study suggests

Taking aspirin to prevent heart attacks or strokes puts the elderly at far greater risk of potentially deadly internal bleeding than first thought a study claims

"Although the risks of major bleeding in patients aged younger than 75 years were like the risks in previous trials of aspirin and other antiplatelet drugs, the risks at older ages were higher and more encouraged at younger ages, and the functional outcome was much worse, with a substantial risk of disabling or fatal upper gastrointestinal bleeding".

He noted that the cost of treating a patient with aspirin and an inhibitor was "very small" in comparison with hospital treatment for a major bleed. "But our study gives us a much clearer understanding of the size of the increased risk and the severity of the consequences".

During the course of the Oxford study, researchers followed about 3,166 patients who had previously had a stroke or heart attack and were prescribed antiplatelet drugs (mostly aspirin).

Roughly 40-60% of adults aged 75 or older in Europe take daily aspirin or other antiplatelet drugs to prevent heart attacks or strokes, as it is recommended for secondary prevention. Over 10 years of the study, a total of 314 patients were admitted to hospital for bleeding. The risk of having disability or even dying after a bleeding event because of complications was 10 times higher for those over age 75 than for younger people.

However, the risk of death due to stomach bleeds was less than 0.5% under 65 years of age, 1.5% for those aged between 75 to 84 of age and 2.5% for people aged over 85.

Although heart attack or stroke risk also increases with age, the researchers said that in the overs 75s major upper gastrointestinal bleeding caused by antiplatelet therapy was at least as likely to be disabling or fatal as recurrent stroke - if a PPI was not co-prescribed.

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Scientists suggest that to reduce these risks, older people should also take stomach-protecting PPI pills.

Authors conclude that proton-pump inhibitors should be co-prescribed in this age group to reduce the risk of bleeds.

There were more cases in stomach bleeds in patients over 75-years-old, while the risk of stomach bleeds in patients under 75-years-old was low.

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. He added that cardiologists and neurologists are influenced more by what they see in practice than what they read in the data, meaning these specialists may not fully realize the risks of aspirin.

Taking a daily aspirin is far more risky than was originally thought and causes more than 3,000 deaths a year in Britain, a major study suggests.

"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". "As with so many things in life, it is a balance of risks versus benefits", says Webberley. However, most people who are now taking daily aspirin for their heart are older. The risk of fatal bleeding clearly increased with age. Up to six in ten Britons aged 75 or older take aspirin to ward off a second heart attack or stroke, or as "health insurance" to protect against cardiovascular disease.

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