The ‘ASPirin in Reducing Events in the Elderly’, or ‘ASPREE’ study, was a randomised, controlled trial of aspirin versus placebo for prevention of CV events, between 2010-2017 by a team of researchers from Australia and the United States. Its aim was to address the insufficient evidence available about the prevalence of significant gastrointestinal (GI) bleeding in older patients treated with aspirin, and to determine the incidence and risk factors of major GI bleeding resulting in transfusion, hospitalisation, surgery or death among patients aged ≥70 years (n = 19,114). 137 upper GI bleeds (aspirin: 89, placebo: 48, hazard ratio [HR]: 1.87, 95% CI: 1.32-2.66, p < 0.01) and a 60% increase in overall bleeding was reported during the median follow-up of 4.7 years. Two fatal bleeds occurred in the placebo group, and an increased risk of bleeding was associated with age, smoking, hypertension, chronic kidney disease and obesity. The absolute 5-year bleeding risk for a 70-year-old not taking aspirin was 0.25% (95% CI: 0.16% – 0.37%), compared to 5.03% (95% CI: 2.56% – 8.73%) for an 80-year-old taking aspirin with further risk factors. While a 60% increase in overall GI bleeding was associated with aspirin, 5-year absolute risk of significant bleeding was moderate among younger, healthier patients. These findings enhance the pool of data available on GI bleeding in older patients and may aid decision making on aspirin prophylaxis in the clinical setting. See the original paper here.

Contributed by AMSS Associate, Isabella Singh