Published: Thu, June 15, 2017
Medical | By Carla Vaughn

Aspirin increases bleeding risk in older stroke patients

Aspirin increases bleeding risk in older stroke patients

Long term consumption of aspirin in stroke patients has been found to cause the risk of fatal or disabling bleeding, increased with age.

To TCTMD, Gurbel noted that the estimated number needed to treat (NNT) to prevent one upper gastrointestinal bleeding event at 5 years was 23 for patients aged 75 to 84 years and 21 for patients 85 years and older.

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.

For the studies, in the University of Oxford, Peter Rothwell led a team in analyzing medical records for higher than 3,000 patients who had a stroke or heart attack and daily taken aspirin or its equivalent for many years.

Rothwell said he personally would not take an aspirin for primary prevention but he also said that for safety reasons no one now taking it daily should stop doing so without consulting their doctor.

The Oxford Vascular Study followed 3166 patients who had previously had a stroke or heart attack and were prescribed antiplatelet drugs (mostly aspirin). Next, coming to the following decade, 314 patients admitted to hospital in case of bleeding. Overall, the risk of disabling or fatal bleeding over ten years was 10 times higher at ages 75 years or older, compared to younger patients. For patients under the age of 65, the annual rate of hospital admissions was 1.5 percent; for patients between the age of 75 to 84, the rate rose to 3.5 percent; and for those over the age of 85 it was five percent.

Authors conclude that proton-pump inhibitors should be co-prescribed in this age group to reduce the risk of bleeds. "Although bleeding is a well-recognised side effect of aspirin, this drug is still seen by many people as harmless, perhaps because of how easily it can be bought over the counter, " he said.

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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.

"Certainly, people should not stop their aspirin if it has been prescribed by a doctor after a stroke or heart attack, since stopping it can cause another heart attack or stroke".

"The second effect of (the) study is its support for the need to use PPIs in patients on anti-platelet therapy aged 75 years or older or in patients with a history of gastro-intestinal bleeds".

The risk of fatal bleeds is still overshadowed by the benefits of aspirin to prevent heart attacks, the research says.

Meanwhile, GP leader Prof Helen Stokes-Lampard, said: "The study does reassure us that, in most cases, aspirin is still the most appropriate course of treatment for patients, but highlights the importance of managing its use carefully and effectively and that some patients may require additional medication to protect them". "In other words, these new data should provide reassurance that the benefits of PPI use at older ages will outweigh the risks".

Professor Sir Nilesh Samani, medical director at the British Heart Foundation, which co-funded the research, said: "For some patients aspirin is an important part of our armoury to prevent heart attacks and strokes".

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