Data extracted from a primary prevention trial showed that aspirin significantly increases overall gastrointestinal (GI) bleeding risk in the elderly. The trial was conducted throughout 2010–2017 (n=19 114) in community-dwelling persons aged ≥70 years with low-dose enteric-coated aspirin or placebo. Over a median follow-up of 4.7 years (88 389 person years), there were 137 upper GI bleeds (89 in aspirin vs 48 in placebo arm, HR 1.87) and 127 lower GI bleeds (73 in aspirin vs 54 in placebo arm, HR 1.36) reflecting a 60% increase in bleeding overall. Multivariable analyses indicated age, smoking, hypertension, chronic kidney disease and obesity increased bleeding risk. The absolute 5-year risk of bleeding was 0.25% for a 70 years old not on aspirin and up to 5.03% for an 80 years old taking aspirin with additional risk factors. The study provides population-based data on GI bleeding in older populations, and suggests a more nuanced approach to prescribing aspirin, taking into account the risk of adverse effects such as bleeding versus the benefit of preventing cardiovascular disease. Source: https://gut.bmj.com/
