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Daily aspirin increases brain bleeds: Study


Michelle Wisbey


27/07/2023 4:29:47 PM

Prescribing healthy patients low-dose aspirin does not prevent stroke but does increase risk of intracerebral bleeding, new research finds.

Man taking aspirin
Low-dose aspirin increases the risk of brain bleeds in healthy patients by 38%.

Groundbreaking revelations from the Aspirin in Reducing Events in the Elderly (ASPREE) trial have added to mounting evidence of the potential harm daily use of the drug for primary prevention can cause.
 
Published in the JAMA Network Open, researchers drew on the data of more than 19,114 initially healthy adults over the age of 70 to undertake the risk/benefit analysis of taking aspirin daily.
 
The participants had no known cardiovascular disease and were randomly assigned either 100 mg of daily aspirin or a placebo tablet over a five-year period.
 
The secondary analysis study found there were minimal differences in the incidence of ischemic stroke between the two groups (4.6% compared to 4.7%) but recorded a 38% increase in intracranial bleeding.
 
‘Low-dose aspirin should not be prescribed for primary prevention in healthy older adults,’ the study concluded.
 
Report senior author and University of Melbourne Professor of Neurology Geoffrey Donnan said the analysis revealed a small but significant risk.
 
‘We were surprised because our hypothesis was that it would be a benefit because it made sense that if it was a benefit after you’d had an event then perhaps it would be a benefit also before you had the event,’ Professor Donnan told newsGP.
 
‘It’s terribly important for [GPs] to absorb that evidence and when they are approached by people saying, “can I go on aspirin?” the short answer, unless there are those specific circumstances, is definitively no.’
 
Stroke remains one of the nation’s biggest killers, with more than 445,087 Australians currently living with its effects.
 
University of Tasmania General Practice Chair Professor Mark Nelson reiterated the data only applied to patients using aspirin for prevention, not for patients using it after a suffering stroke.
 
‘The message is not for people who have established cardiovascular disease, it’s the primary prevention population, people who have never manifested the disease,’ Professor Nelson told newsGP.
 
‘Don’t have your over-70s on aspirin unless they’ve had a previous heart attack or stroke.
 
‘It’s usually recommended because it’s an over-the-counter drug and it’s very cheap … and that’s why people can be on it and their own doctor might not even know they’re on it.’
 
He said instead of aspirin, GPs should focus on mitigating the well-known risk factors to prevent stroke, including encouraging patients to stop smoking or controlling blood pressure.
 
Professor Donnan said more research needs to be done to determine the link between low-dose aspirin and other illnesses.
 
‘We’re continuing to follow people up to see whether it, for example, prevents cancer and all sorts of things,’ he said.
 
‘It’s an area that really does need a lot more research to determine what its short-term and long-term benefits actually are.’
 
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