Aspirin increases bleeding risk in older stroke patients

15 June, 2017, 02:06 | Author: Garry Little
  • Aspirin

They concluded that among patients aged 75 or older, the overall risk of developing serious bleeding was 10 times higher - which the authors concluded was "at least as likely to be disabling or fatal" as another stroke. For patients aged 75-84, the annual rate rose to approximately 3.5% and to 5% for patients aged over 85.

Faculty of Pharmaceutical Medicine President Alan Boyd, who was not involved in the study, said it had been considered that the benefits of aspirin outweighed the risks of bleeding in all patients and that the new research would force a reappraisal.

A new study has linked over-75s who take a daily aspirin tablet after a stroke or heart attack, with an increased risk of stomach bleeds than previously thought.

He says the answer is for people taking aspirin to be prescribed heartburn drugs known as proton-pump inhibitors (PPIs), which reduce the risk of bleeding by 70% to 90%.

He added: 'However, suddenly stopping medication is definitely not advised, so patients should always talk to their doctors'.

Half the patients were 75 or older at the start of the period covered by the study.

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

During this time 314 patients were admitted to hospital for internal bleeding.

They found that, for patients aged under 65, the annual rate of disabling or fatal bleeds was less than 0.5% (around one person in every 200 people taking the medication).

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

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Researchers have known for some time that aspirin can increase the risk of stomach bleeds.

The risk of major bleeding, including fatal bleeds and major upper GI bleeds, increased dramatically with age.

Aspirin, or acetylsalicylic acid (ASA) is a common drug that is used to treat mild to moderate pain and reduce fever or inflammation.

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".

Patients that are anxious about major bleeds during use of aspirin should seek medical advice from their doctor before considering to go off aspirin or limit its use.

The researchers found that while the risk of non-major bleeding was unrelated to age, the risk of major bleeds, and particularly fatal bleeds, increased steeply with age. "In other words, these new data should provide reassurance that the benefits of PPI use at older ages will outweigh the risks".

After a transient ischemic attack, ischemic stroke, or myocardial infarction, aspirin is commonly taken to prevent a recurrent event. "As with so many things in life, it is a balance of risks versus benefits", says Webberley.

There are very well established preventative effects that the aspirin has in people who have had a major heart problem, by reducing the risk of another attack or stroke by 20%.

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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