Drug taken daily by 19million Americans increases risk of bleeding

A quarter of older adults are still taking a drug that could cause them to suffer from internal bleeding, a study has found.

Aspirin was once recommended for people over 60 in the US as a way to prevent a heart attack or stroke. 

But in 2018, medical organizations began to dial back the advice, saying that for those who hadn’t suffered from the conditions before, any benefits were outweighed by the risks — which include bleeding in the intestines or the brain.

While the study found use of aspirin did fall in the age group after the change in recommendation, it also revealed that 18.5million seniors were still using it in 2021, the latest date available. 

Of these, 3.3million — or nearly five percent of the over 60s population — were doing so without any medical advice.

Aspirin is still recommended for people over 60 who have already suffered from a heart attack or stroke because it can slash the risk of a second by approximately 25 percent.

It is an inexpensive drug — costing as little as nine cents per tablet — and works by thinning the blood, reducing the risk of clots forming.

This helps decrease the risk of a stroke or heart attack because patients are less likely to have clots that could cause blockages in the brain or heart.

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But doctors have warned the medication also raises the risk of internal bleeding by reducing the ability of factors in the blood to clump together to form clots and stem a potentially serious bleed.

These bleeds typically occur in the stomach or intestines and can be life-threatening because patients may suffer from severe loss of blood, which could lead to shock, damage critical tissue or interrupt the supply of nutrients and oxygen to vital areas of the body. In some cases, they also occur in the brain.

Doctors say these bleeds can prove fatal in rare cases. 

In the study, published this week in the Annals of Internal Medicine, researchers analyzed data from 180,000 patients aged 40 and older who were asked about their aspirin use between 2012 and 2021.

The data was collected from the National Health Interview Survey (NHIS), a yearly survey of 35,000 adults on their health habits.

Researchers at Creighton University, in Nebraska, and Houston Methodist University, in Texas, analyzed the data to estimate aspirin use among people in their 60s and beyond.

They found 18.5million people without cardiovascular disease were using preventative aspirin in 2021, with 3.3million of those using the pills without a recommendation from their doctor.

They noted limitations of the study included it was likely that doctor-recommended use of aspirin in the age group was also included in the estimates.

The drug is still recommended for those over 60 who have already suffered from a heart attack or stroke because it can reduce the risk of a second.

Some doctors will also recommend the drug for select individuals who have evidence of significant plaque in their arteries, raising the risk of clots.

Studies have also previously found among people over 60 the benefit of reducing the risk of a first heart attack or stroke was not outweighed by the risk of a brain bleed. 

About seven percent of adults over 60 have had a stroke, or 5million people. 

Separate figures show that 14 percent of people aged 65 to 74 years old have also had a heart attack, or 4.6million people.

Doctors slowly began to stop recommending using the drug to prevent a first heart attack or stroke in 2018 after three clinical trials warned over potential risks.

The American College of Cardiology changed its guidelines in 2018 and the American Heart Association shifted them in 2019 to suggest senior over 70 who had not yet suffered from a heart attack or stroke should not take aspirin.

In 2022, the US Preventive Services Task Force followed suit — saying those over 60 years old should not take aspirin to prevent a first heart attack.