Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly.

Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly was published in The New England Journal of Medicine in October 2018 and was the largest primary prevention study ever undertaken in healthy older people.   The study concluded that aspirin failed to lower their risk of cardiovascular disease, and also increased their rate of bleeding and was associated with a higher rate of death.

The research has been one of the most widely discussed articles over the past few months and challenged traditional notions.    What do you think?  Were you surprised, and do you agree with the study's methodology and conclusions?

Read the full study here (open access), and share your thoughts below.

17 Comments
Order by: Votes | Oldest | Newest
Nancy R Gough
Nancy R Gough
PhD
BioSerendipity
Owner
Elkridge, MD, United States
3weeks ago

I noted this study when it came out. I was not surprised by the findings. I think one of the key points to remember is that this is not a study of elderly patients with heart or vascular disease or any form of dementia or disability. These were healthy elderly subjects, based on those criteria. Thus, a small, but significant, increase in risk of serious bleeding from taking an irreversible, noncompetitive inhibitor of an enzyme involved in blood clotting should not be surprising. Furthermore, drug metabolism is altered in the elderly as is blood cell production. So, altering clotting ability in otherwise healthy elderly people may increase the risk of bleeding complications.  This study does not mean that there may not be some elderly in this "healthy" group who can benefit from cyclooxygenase inhibitors but that simply using age as the criteria is not sufficiently personalized for using these drugs to prevent or reduce the risk of cardiovascular events in people without such conditions or risk factors for these conditions already present. A strength of this study is the large number of subjects. A limitation is that by selecting only healthy elderly, the rate of cardiovascular disease was much lower than predicted from other studies that did not use such criteria for subject selection. 

Recommended 3 times
Read Roberts
Read Roberts
PubFacts.com
Thanks for so much detail!
3weeks ago
Professor (Dr.) Pranab Kumar Bhattacharya
Professor (Dr.) Pranab Kumar Bhattacharya
MD ( Calcutta University)
School of Tropical Medicine Kolkata Presently on detailment post
Professor and Head Pathology
Kolkata, West Bengal, India
3weeks ago

 The Aspirin is a wonderful magic bullet in low doses (50mg) or 75 mg  enteric coated tablet not only to prevent ischemic stroke ( thrombosis) in brain and  or TIA  but also for  secondary cardiovascular mortality in patients who had history of past AMI or IHD or CAD and also for those patients  with stents  or CABG  or  valvular replacements along with  drugs warferin  and to prevent large Gut  ( colonic )carcinomas. however in Indian patients  of above age 65 years (elderly) the drug increases incidences of intra cerebral bleeding and hemorrhagic shock. So those having aspirin should monitor platelet count at least 3 months interval and should be cautious to take aspirin

Recommended 2 times
Arghya Ray
Arghya Ray
Livingston Research
Your research must be formally published, sir. You are telling the things from practical experience. Please write them down in the theoretical context of medicinal practice. Your opinion will count as a counter-current in the milieu of international research trends.
1week ago
Dr. Maha Othman
Dr. Maha Othman
MD PhD
Queen's University
Associate professor
Kingston, Ontario , Canada
3weeks ago

Hypercoagulability due to various reasons can increase risk of cardiovascular events.

There are infuvidual variations in blood coagulability so as in responses to low dose aspirin. Assessing changes in the coagulation profile over time can contribute to assessing this risk.

 Unfortunately conventional laboratory tests are not sufficiently sensitive and unable to pick subtle changes. More importantly are mostly designed for bleeding  not thrombotic tendencies.  

Thromboelastography studies in various discipline show this technique can help out but unfortunately still not applied for this purpose. https://www.ncbi.nlm.nih.gov/m/pubmed/?term=maha+othman+thromboelastography

Recommended 2 times

Personally I do not agree with this study!! especially in the secondary prevention,

I am vascular surgeon,

in the management of arterial occlusive or aneurysmal  pathology, anti platelet  have proven their efficacy in mono or bi therapy,

for example: for PAD( peripheral arterial disease)  in pre- and post-operative , aspirin is prescribed at a dose of 200mg / day;  and if Endovascular treatment: aspirin 100 mg / day + clopidogrel,

the same for carotid stenosis,

it is also included in the medical treatment protocol (BMT= best medical treatment) of  aortic dissections  and IMH (intra mural aortic hematoma),

in our experiece, we did not have any bleeding, except for a few rare cases of ecchymosis  in patients with thrombocytopenia,

and in cases with  gastric ulcer we have always advocated clopidogrel instead of aspirin.

Moreover, we have seen in patients who have stopped their treatment : bypass thrombosis or angioplasty thrombosis.

For the study to be validated, it is necessary to do a meta Analysis on randomized studies,

It remains to prove!!

Dr Souad BENALLAL

Recommended 1 time
Dr Monica BUTNARIU
Dr Monica BUTNARIU
chemist
Banat's University Timisoara
doctor habilitate, professor
Timisoara, Romania
3weeks ago

I'm not surprised by the result.

Respect the working methodology of the authors.

Recommended 1 time

in primary prevention, There are some factors to consider:

not only age!

healthy patient, even elderly,

the only prevention is hygieno-dietetic measures,

we will not use drugs

however, association of other pathologies such as diabetes or HTA is justified

give somebody a healthy medication to prevent an event for me  "is an aggression of the body and not a prevention"!!

Dr Andiappan Rathinavel
Dr Andiappan Rathinavel
M.S, M.Ch ,Ph.D
Madurai Kamaraj University, & Madurai Medical college
Molecular Cardiology, Cardio -Thoracic Surgery
Madurai --625017., Tamilnadu, India
3weeks ago
  • Couldn't able to access full article.

Not able to comment .

Kindly help me

Thanks

Dr.Ing Nditange Shigwedha
Dr.Ing Nditange Shigwedha
BSc, MSc, PhD, Post-PhD
Harbin Institute of Technology (HIT)
Harbin, China
3weeks ago

Those were fascinating findings, and I am not surprised at all.

I believe it.

Prof Abdulazeez T Lawal
Prof Abdulazeez T Lawal
PhD
Fountain University Osogbo Nigeria
Prof
osogbo, osun, Nigeria
3weeks ago

It is really erroneous to assume that aspirin reduces heart attack and other coronary problems as old age approaches. With this study, other drugs should be investigated using the same numbers of people.

Dr Alfredo I Servín-Caamaño
Dr Alfredo I Servín-Caamaño
Md
Hospital general de mexico
Dr
Mexico city, Mexico, Mexico
3weeks ago

The most recent evidence show that aspirin havent bennefit in primary prophilaxis speciually in diabetic patients, a recent meta analysis show that only served in primary in a health people but with a very important risk of bleeding.


Dr Felix Uchenna Samuel
Dr Felix Uchenna Samuel
DVM, MSc
Ahmadu Bello University
Dr
Zaria, Kaduna, Nigeria
2weeks ago

I am not surprised at the results of this study. Aspirin is an NSAID which could block COX I and COX II enzymes leading to haemorrhages. This study was conducted among old people and as a primary cardiovascular disease control agent so the incident of its side effect of causing haemorrhages will high however the use of NSAID has currently been in conjunction with mefepristol which is capable of ameliorating the haemorrhages caused by NSAID used alone

Dr. Robert John Zagar
Dr. Robert John Zagar
PhD MPH
Juvenile Division Circuit Court of Cook County, ART LLC, Chicago School of Professional Psychology
Psychologist, General Manager, Professor
Chiago, Illinois, United States
1week ago

I wonder if your patients might benefit more from reading and doing Professor Tombak's books suggestions, Cure the Incurable and Can We Live 150 Years.

Arghya Ray
Arghya Ray
Livingston Research
A Level Writer
India
1week ago

This research was extremely necessary. Aspirin is used by doctors in the class of NAISD drugs with an aim to prevent bleeding. But dangers due to such interventions were not well understood. In the context of further research, McNeil et al (2018) have done a wonderful job. They have the guts to say that aspirin usage is dangerous. Statistical correlation underlying this finding would potentially compel the medical policymakers to do something concrete for controlling prescription frequencies around aspirin and related substances. In the first half of 20th century, quinine was used as an anti-fever drug almost indiscriminately. The results were not very good of course. Today, aspirin might also be heading towards such kind of intervention frequencies. From bad tooth to heart attacks, aspirin is pushed time and again. It is time to stop for the doctors and paramedics alike. Previous research on aspirin usage to prevent upper GI bleeding had left questions. Many other researchers, during beginning of the 2000s, pointed out that more inquiry should be done to understand aspirin interactions for heart ailments and stroke aftermaths. McNeil et al (2018) have directly hammered through, and risks associated with aspirin have become almost meaningless now. Aspirin must be avoided. Period.

Bibliography

Cryer, B. (2010). Reducing the gastrointestinal risks of low-dose aspirin. Gastroenterology138(1), 30-33

De Berardis, G., Lucisano, G., D’ettorre, A., Pellegrini, F., Lepore, V., Tognoni, G., & Nicolucci, A. (2012). Association of aspirin use with major bleeding in patients with and without diabetes. JAMA307(21), 2286-2294

Whitlock, E.P. et al (2016), Evidence Summary: Bleeding risks with aspirin use, Annals of Internal Medicine, April Issue

Md Lemon Hasan
Md Lemon Hasan
MSc. in Medical Science
Korea Institute of Science and Technology
Graduate student
Seongbuk-gu, Seoul, Bangladesh
1week ago

As Aspirin is one of the most used medication for various diseases including cardiovuscular disease, I would think its really  harsh the findingss. However,  its not surprising that aspirin would not help for hert disease while sampling group were healthy late aged peoples. Though aged peoples were sampling randomly, there are many other complexity which might not suited the aspirin for older peoples.. 

Frankline Sevidzem Wirsiy
Frankline Sevidzem Wirsiy
BSc, MSc, PhDc
University of Buea
Ph.D.c
Douala, Littoral, Cameroon
2 days ago

 I concur with finding reported by McNeil et al. reporting that the use of low-dose aspirin as a primary prevention strategy in older adults resulted in a significantly higher risk of major hemorrhage and did not result in a significantly lower risk of cardiovascular disease than placebo. Though, clarifying the role of aspirin in disease prevention for older adults is a research field that needs to be given much attention to. It is equally worthy to note that clinical guidelines have established benefits of aspirin for preventing heart
attacks and strokes in persons with vascular conditions such as coronary
artery disease

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