HomeLifestyleHealth & FitnessFor Stroke Prevention in Older People, Popular Drug May Be Harmful

For Stroke Prevention in Older People, Popular Drug May Be Harmful

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It may increase the risk of stroke and intracranial bleeding, according to the latest study.

Aspirin, an antiplatelet agent typically administered in low quantities (75-100 mg/d), has been long leveraged for warding off cardiovascular events.

However, despite some unfavorable discoveries, its use persists in the realm of primary and secondary stroke prevention, with an increase in bleeding tendency as a major side effect.

Is Aspirin Safe For Stroke Prevention In Healthy Elderly?

Insights into the effectiveness of small-dose aspirin for primary stroke prevention originate from meta-analyses and recent key trials, most of which were carried out in age groups under 70 years.

Amidst some variations, these studies hint at a pattern of decreased ischemic stroke offset by an escalation in intracerebral and other types of intracranial bleeding. This results in a negligible overall effect on the total stroke occurrence.

Elderly individuals exhibit certain clinical features, including a heightened inherent tendency towards bleeding, which could be linked to the increased frailty of small blood vessels. Moreover, the elderly are more prone to significant and minor injuries due to falls and other mishaps.

Taken together, these outcomes could tip the balance of risks and rewards of an antiplatelet drug. This becomes particularly relevant in a primary prevention scenario for individuals with low-risk profiles. Given the rising stroke risk in the elderly, the growing global elderly population, and the criticality of evaluating preventive measures for this age bracket, these concerns are of high importance.

The Aspirin in Reducing Events in the Elderly (ASPREE) trial stands as the largest randomized controlled trial on low-dose aspirin. It aimed at scrutinizing the balance of risks and rewards of this treatment among the elderly.

The ASPREE trial’s robust design incorporated independent assessment of stroke and bleeding events by autonomous expert panels. Hence, it was well-equipped to probe into the pros and cons of small-dose aspirin in a primary prevention scenario. In this research, we present an exhaustive report on the first occurrence of stroke and bleeding events during the median of 4.7 years of trial follow-up.

This auxiliary analysis of the ASPREE trial, a randomized, double-blind, placebo-controlled study of daily low-dose aspirin, was carried out among community-dwelling individuals residing in Australia or the US. These participants were elderly individuals devoid of symptomatic cardiovascular ailments. Recruitment spanned from 2010 to 2014, and participants were followed for a median (IQR) duration of 4.7 (3.6-5.7) years. This analysis was performed between August 2021 and March 2023.

Participants were randomly assigned either daily 100-mg enteric-coated aspirin or a matching placebo.

Out of 19,114 elderly participants (10,782 females [56.4%]; median [IQR] age, 74 [71.6-77.7] years), 9525 received aspirin and 9589 received a placebo.

Should older adults take aspirin for stroke prevention?

The current analysis shows no significant reduction in ischemic stroke incidence was observed with aspirin use (HR, 0.89; 95% CI, 0.71-1.11).

But, it shows a side effect of low-dose aspirin.

A significant surge in intracranial bleeding was noticed among those assigned to aspirin (108 individuals [1.1%]) versus those on placebo (79 individuals [0.8%]; HR, 1.38; 95% CI, 1.03-1.84).

This was due to an increase in a combination of subdural, extradural, and subarachnoid bleeding with aspirin compared to placebo (59 individuals [0.6%] vs 41 individuals [0.4%]; HR, 1.45; 95% CI, 0.98-2.16).

Hemorrhagic stroke occurred in 49 individuals (0.5%) on aspirin as compared to 37 individuals (0.4%) in the placebo group (HR, 1.33; 95% CI, 0.87-2.04).

Should individuals at low risk of stroke be recommended aspirin?

This data implies that low-dose aspirin may not be beneficial for the primary prevention of stroke.

Caution is advised in prescribing aspirin for elderly individuals more prone to head injuries (e.g., due to falls).

The findings of the study were published today in JAMA Open Network.

Image Credit: Shutterstock

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