The daily low-dose aspirin use among older adults can result in a 20 percent higher likelihood of developing anemia, even without experiencing major bleeding incidents, reveals a recent randomised controlled trial.
The study, which examined data from the Aspirin in Reducing Events in the Elderly (ASPREE) trial and was published in the Annals of Internal Medicine on June 20, uncovered that
Led by Dr Zoe McQuilten, MBBS, PhD, a hematologist at Monash University in Australia, the research focused on 19,114 healthy older individuals residing in the community and examined their hemoglobin levels, observing an increased risk of anemia during the trial period, likely due to non-clinically apparent bleeding caused by low-dose aspirin.
Anemia, commonly found among elderly patients, can manifest various symptoms such as fatigue, irregular heartbeat, headache, chest pain, and a pulsing or whooshing sound in the ears, as described by the Cleveland Clinic. Furthermore, anemia can exacerbate existing conditions like congestive heart failure, cognitive impairment, and depression in individuals aged 65 and older.
In 2022, the US Preventive Services Task Force revised its recommendation on aspirin for primary prevention of cardiovascular disease, discouraging the initiation of low-dose aspirin for adults aged 60 years or older. For adults aged 40 to 59 with a 10pc or greater 10-year risk of cardiovascular disease, the agency suggests a case-by-case approach to decision-making between patients and clinicians, considering the minimal overall benefits of low-dose aspirin use.
Dr McQuilten, the lead author of the study, has dedicated the last five years to designing sub-stages of anemia and investigating conditions such as blood cancer. In many cases, identifying the underlying cause of anemia has proven challenging for medical professionals. A study published in the Journal of American Geriatrics Society in 2021 found that approximately one third of anemia cases had an unclear etiology.
During the course of the latest study, around 50pc of participants aged over 60 used aspirin for prevention between 2011 and 2018. Although this number likely decreased following the guideline changes in 2022, it is possible that long-term aspirin use persisted among older patients. The research team also evaluated ferritin levels, which serve as an indicator of iron levels, at the beginning of the study and after three years.
The study revealed that the occurrence of anemia was 51 events per 1,000 person-years in the aspirin group, compared to 43 events per 1,000 person-years in the placebo group. Furthermore, the estimated probability of developing anemia within five years was 23.5pc (95pc CI: 22.4pc to 24.6pc) in the aspirin group and 20.3pc (95pc CI: 19.3pc to 21.4pc) in the placebo group. Consequently, the researchers determined that aspirin therapy increased the risk of anemia by 20pc (95pc CI: 1.12 – 1.29).
These findings provide valuable insights into the use of aspirin among older individuals and emphasise the need for heightened awareness and caution. Patients and healthcare professionals are encouraged to consider the potential risks associated with low-dose aspirin, particularly regarding the development of anemia.
