Daily low-dose aspirin increases the incidence of anemia in the elderly

A secondary analysis of the randomized ASPREE trial showed that daily low-dose aspirin increased anemia in otherwise healthy older adults.

The incidence of anemia over a median of 4.7 years was 51.2 per 1000 person-years in the aspirin group compared with 42.9 per 1000 person-years in the placebo group (HR 1.20, 95% CI 1.12-1.29). Zoe reported. His MBBS Dr. McQuilten and colleagues at Monash University, Melbourne, Australia.

The estimated odds of anemia within 5 years were 23.5% for aspirin users and 20.3% for placebo users, the researchers reported. Annals of Internal Medicine.

Treatment effects were similar in a sensitivity analysis that considered cancer incidence (HR 1.20, 95% CI 1.11 to 1.30) and after adjusting for characteristics associated with increased risk of anemia (adjusted HR 1.19, 95 %CI 1.11-1.28).

Furthermore, the placebo group decreased hemoglobin levels by an average of 3.6 g/L over 5 years, while the aspirin group had a lower estimated baseline mean of 0.4 g/L and a steep decline in hemoglobin of 0.6 g/L over time. has occurred. g/L per 5 years compared to placebo.

And among more than 7,000 participants who had ferritin measured at baseline and over 3 years, participants in the aspirin group were more likely to have ferritin levels below 45 mg/L at 3 years (13% in the placebo group). , 9.8% in the placebo group), the overall decline in ferritin was greater. 11.5% compared to placebo.

Of note, 3% of participants in the aspirin group experienced at least one clinically significant bleeding event compared to 2.1% of participants in the placebo group.

“Large clinical trials, including the ASPREE trial, have shown that taking low doses of aspirin daily increases the risk of clinically significant bleeding,” McKilten said. Today’s Medpage on mail. “Our study found that low-dose aspirin also increased the risk of developing anemia during the trial, most likely due to bleeding that was not clinically apparent.”

“For many people, anemia can cause other effects, such as fatigue and a general decline in functioning and cognition,” she added.

The incidence of anemia is known to increase with age, Estimate Approximately 17% of adults over the age of 65 have anemia, and its prevalence is higher among those in nursing homes and hospitals.

Previous research Anemia in the elderly has been associated with increased all-cause mortality, poor quality of life, increased incidence of cardiovascular disease (CVD), increased risk of falls and fractures, and longer hospital stays. shown. previous result Findings from the ASPREE trial showed an association between low-dose aspirin use and increased all-cause mortality and cancer mortality in the elderly.

The increased health risks and cost of treatment associated with anemia in the elderly are “restricting the use of low-dose aspirin to those with evidence-based indications and preventing iron-deficiency anemia in those taking aspirin regularly.” ,” the authors wrote.

William Han, MD, MPH, of the Icahn School of Medicine in Mount Sinai, New York City, said: Today’s Medpage In addition to the known risks of serious bleeding events, the results of the study indicate that occult blood loss and anemia are “potential harms for older adults taking aspirin as primary prevention.”

“American Preventive Services Task Force” already recommended “Low-dose aspirin should be avoided for primary prevention in people over the age of 60,” he said, adding that “this study further strengthens the evidence for that recommendation.”

This post hoc analysis ASPREE (Aspirin in Event Reduction in the Elderly) Trial 19,114 participants aged 70 and older (65 and older for black and Hispanic adults) in the United States and Australia were randomly assigned to receive 100 mg of aspirin daily or placebo. All participants had a mean age of 74 years, 56% were female, and 93% were white.

The risk of aspirin was consistent across sex and age, including chronic kidney disease, diabetes, alcohol and tobacco use, previous use of aspirin, and continued use of low-dose nonsteroidal anti-inflammatory drugs and proton pump inhibitors. The same was true for some people.

McQuilten et al. noted that anemia may have been identified and treated by an outside expert during the annual evaluation, which may have led to an underestimation of the incidence of anemia.