Regularly taking aspirin is damaging for healthy, older individuals

Aspirin is a common medicine highly effective in controlling pain, fever and inflammation; but it is also used for thinning the blood and reducing the risk of serious problems such as heart attacks and strokes.

Long-term treatment with low doses of aspirin – usually 75mg – has an antiplatelet effect, which means it makes the blood less sticky and can stop blood clots developing. It is often recommended for people with risk factors which mean they are more likely to develop a blood clot, and then possibly a heart attack or stroke triggered by the clot. This usually includes people with a history of heart disease or stroke.

The latest clinical trial wanted to see if aspirin also had benefits for older adults with no history of cardiovascular (heart and circulation) disease. The clinical trial followed more than 19,000 healthy older people in Australia and the United States, who hadn’t previously suffered a stroke or heart attack and took a daily low-dose of aspirin. The trial began in 2010 and enrolled participants aged 70 and older. The participants were randomly divided into two groups – one group received aspirin and the other a placebo (dummy treatment) and the participants were monitored over a four year period.

The trial revealed that those that took aspirin were at a ‘significantly’ increased risk of major internal bleeding, primarily in the gastrointestinal tract and brain (an uncommon but serious side effect of aspirin), than those in the placebo group. There was no difference between the two groups in the combined outcome of death, disability or dementia. Neither was there significant difference in the rates of cardiovascular disease.

In the UK, routine use of aspirin in older people who do not have a history of cardiovascular disease is not recommended, unless people are assessed as having an increased risk of cardiovascular disease. This may include, for example, people with heart rhythm problems such as atrial fibrillation.

Prof Peter Rothwell of Oxford University, a leading expert on the drug, said the clinical trial findings were definitive and that ‘self-medicating with aspirin in the absence of a definite medical indication isn’t advisable.’

The clinical trial supports current understanding that for older adults with no previous history of cardiovascular disease, the benefits of taking aspirin are small and do not outweigh the risks.
But if you have been advised to take aspirin due to a history of cardiovascular disease you should not stop taking it without first talking to your GP. The benefits in terms of preventing further cardiovascular problems are considered to outweigh the risks of bleeding and damage to the stomach lining.

It is worth noting that this trial included only generally healthy older adults, and excluded people with certain health conditions such as atrial fibrillation, dementia and significant physical disabilities. Many people over 70 may have an existing health condition, as such the participants of the trial do not represent all older people. Doctors need to assess the risk of cardiovascular disease and balance the risks against benefits of aspirin on an individual basis.

Overall, aspirin is a beneficial medicine for people who have a history of heart or vascular problems, and is also likely to benefit certain individuals at a higher risk of developing these problems. The most important thing is to be guided by your doctor.

Loveness Chihoyi, Trainee Legal Executive in the Medical Negligence team at Ashtons Legal, comments: “We often read of patients being informed to take daily aspirin for reasons that are unclear. Whilst this study seems to show that the long-term risks of taking aspirin seem to outweigh the benefits in otherwise healthy individuals, there does seem clear benefit to patients who suffer a mini stroke/Transient Ischemic Attack (TIA).

“We also often see cases in those circumstances where patients are then discharged without any form of preventative medication who proceed to suffer a full blown stroke. Although it is recommended not to take aspirin daily in healthy older people, it is well known that there are real benefits in taking aspirin in the initial phases after suffering a TIA in order to prevent further mini strokes/TIAs or a full blown stroke”.