Aspirin May Cause Serious Bleeding in Older Stroke Patients

The risk of internal bleeding from swallowing blood-thinning aspirin pills is far higher in over-75s than was previously thought say researchers

The risk of internal bleeding from swallowing blood-thinning aspirin pills is far higher in over-75s than was previously thought say researchers

"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".

The researchers suggest that people could take proton pump inhibitors (PPI) which is a kind of heartburn medication that can reduce bleeding in the upper gastrointestinal tract by up to 90 percent.

Previous studies have shown there is a clear benefit of short-term antiplatelet treatment following a heart attack or stroke. The proportion of survivors for whom a bleed resulted in a new, or sustained increase in disability rose, from 3 per cent (4/157) for people aged under 75, to 25 per cent (46/183) for over 75s.

Rothwell, director of the Center 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 to 84, and almost 2.5 percent for over-85s.

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.

But the clinical tests underlying these recommendations involved mostly patients aged less than 75 who had taken aspirin for at the most two years. "So this is why a clinician needs to consider many issues and discuss these with the individual older patient - and be ready to review if any problems develop". Over the 10-year period, 314 patients were admitted to hospital for bleeding.

Prof Rothwell said: "While there is some evidence that long-term PPI use might have some small risks, this study shows that the risk of bleeding without them at older ages is high, and the consequences significant".

Millions of pensioners take the blood-thinning pills to ward off heart attacks and strokes.

Numerous studies have shown that taking a low-dose aspirin a day can prevent a heart attack or stroke.

"It is clear from the data presented that - in the over-75s - taking PPI along with aspirin was associated with a reduced likelihood of bleeding", said Tony Fox, a professor in the Pharmaceutical Medicine Group at King's College London.

While the drugs had "tiny benefits" for such patients in mid-life, in reducing the risk of heart disease and cancer, the dangers increase with age, he said.

'Also when major bleeding does occur in this older patient group it is more likely to be severe leading to increased hospitalisation and can be fatal'. "Prescription of any drug is a balance between the benefits of the medication against its risks, and aspirin is no different", he said. "Regardless of age, nobody should suddenly stop taking aspirin without speaking to their doctor", Rothwell said.

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