Intended for healthcare professionals

Rapid response to:

Research News

Daily aspirin doesn’t prevent deaths or disability in healthy older people, trial finds

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3923 (Published 16 September 2018) Cite this as: BMJ 2018;362:k3923

Rapid Response:

Risk of major bleeds not appreciated by many patients

Although this study only examined patients newly starting on aspirin I am hopeful that the alarming results (aspirin appearing to increase the risk of major haemorrhage by 36% compared to a placebo) will provide fresh impetus to reduce the number of elderly patients already unnecessarily taking aspirin as primary prevention. Previous studies have shown ongoing risks of significant bleeds in those already taking aspirin and in the absence of current evidence to the contrary it would seem reasonable to assume that the results of this study would apply similarly to those patients.

Effecting any change however will require a major targeted effort from GPs and ANPs to proactively raise the issue with patients and encourage them to consider ‘giving up’ the aspirin. I know from experience that these patients are not always easily persuaded that the drug they have been taking for 20 years is probably more of a risk than a benefit to them and the number of patients involved is not insignificant by any means.

At my previous GP practice almost a third of over 75s were on aspirin and though most were prescribed it appropriately as secondary prevention a significant number were taking it as primary prevention (presumably having remained on it for decades!). Patients that cannot be dissuaded from self-medicating with aspirin could benefit from being offered a PPI (possibly reducing the risk of a major UGIB by up to 74% (1)) however it would be preferable all round if we could simply eliminate the use of aspirin as primary prevention at all and remove the considerable risks of both aspirin and PPIs!

(1) Mo C, Sun G, Lu ML, et al. World J Gastroenterol 2015; 21: 5382–92.

Competing interests: No competing interests

16 September 2018
Daniel Barrett
Doctor
Newcastle Upon Tyne