HFHT's Practising Wisely Newsletter
For the whole healthcare team.
Issue 60: Just Say No to Aspirin for the Well Elderly
September 25, 2018
A question physicians are often asked is: “Doc, should I be taking an aspirin every day?”

Presumably, people are influenced by the oft quoted benefits of ASA (Acetylsalicylic Acid, a.k.a. aspirin) in the m edia – promises to reduce heart attack, stroke, cancer, and dementia.

The ASPREE study enrolled 19,114 community-dwelling persons in Australia and the United States who were “elderly”. They defined elderly as being 70 years of age or older, or ≥65 years of age among blacks and Hispanics in the United States.This was a randomized, double-blind, placebo controlled trial and was supported by a grant (U01AG029824) from the National Institute on Aging and the National Cancer Institute at the National Institutes of Health, by grants (334047 and 1127060) from the National Health and Medical Research Council of Australia, and by Monash University and the Victorian Cancer Agency.

The results of 3 arms of the study were recently published in the NEJM (check out the results of the three arms in our Quick Links section). Aspirin use in healthy elderly persons did not prolong disability-free survival over a period of 5 years but led to a higher rate of major hemorrhage than placebo.

As you'll see in the article in the NEJM, "the use of low-dose aspirin as a primary prevention strategy in older adults resulted in a higher risk of major hemorrhage and did not result in a significantly lower risk of cardiovascular disease than placebo."

The authors also state that "Higher all-cause mortality was observed among apparently healthy older adults who received daily aspirin than among those who received placebo and was attributed primarily to cancer-related death."

So, the evidence is compelling. For patients with a history of heart attack or stroke , previous research is clear and has shown that the benefits of daily aspirin use outweigh the risk. For healthy older adults , however, evidence suggests that taking a low-dose aspirin daily is, at best, a waste of money, and at worst, may raise their risk of internal bleeding and early death.
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