A UK prospective population-based study of long-term antiplatelet treatment (predominantly daily aspirin 75 mg enteric coated) in secondary prevention of vascular disease showed that the severity, case fatality, and poor functional outcome of bleeds increased with age, and that in patients aged 75 years or older, most major upper gastrointestinal bleeds were disabling or fatal. The study identified 3166 patients (1582 aged ≥75 years). There were 405 first bleeding events (218 gastrointestinal, 45 intracranial, and 142 other) during 10 years (13 509 patient-years) of follow-up. Risk of non-major bleeding was unrelated to age, but major bleeding increased steeply with age (≥75 years hazard ratio [HR] 3·10), particularly for fatal bleeds (HR 5·53), and was sustained during long-term follow-up. The same was true of major upper gastrointestinal bleeds (≥75 years HR 4·13), particularly if disabling or fatal (HR 10·26). At age 75 years or older, major upper gastrointestinal bleeds were mostly disabling or fatal (45 of 73 patients vs 101 of 213 patients with recurrent ischemic stroke), and outnumbered disabling or fatal intracerebral hemorrhage (45 vs 18), with an absolute risk of 9·15 per 1000 patient-years. The estimated numbers needed to treat for routine proton-pump inhibitor (PPI) use to prevent one disabling or fatal upper gastrointestinal bleed over 5 years fell from 338 for individuals younger than 65 years, to 25 for individuals aged 85 years or older. The findings are in line with previous studies and suggest that co-prescription of PPI should be encouraged in patients aged 75 years or older with aspirin. Source: http://www.thelancet.com/
