Antiplatelet Bleeding Risk Higher Than Expected for Older Patients
Research suggests proton-pump inhibitors should be co-prescribed in patients age 75+ years
WEDNESDAY, June 14, 2017 (HealthDay News) -- Long-term daily aspirin use is linked to a higher-than-expected risk of disabling or fatal bleeding in patients aged 75 and over, according to a study published online June 13 in The Lancet.
Linxin Li, D.Phil., from the University of Oxford in the United Kingdom, and colleagues conducted a population-based cohort study involving patients with a first transient ischemic attack, ischemic stroke, or myocardial infarction treated with antiplatelet drugs (mostly aspirin) from 2002 to 2012, with follow-up to 2013.
The researchers found that during 13,509 patient-years of follow-up, 3,166 patients had 405 first bleeding events. There was no correlation for the risk of non-major bleeding with age; major bleeding increased with age (≥75 years: hazard ratio, 3.10), especially for fatal bleeding (hazard ratio, 5.53), which was sustained during follow-up. Similar trends were seen for major upper gastrointestinal bleeds (≥75 years: hazard ratio, 4.13), especially if the bleeding was disabling or fatal (hazard ratio, 10.26). To prevent one disabling or fatal upper gastrointestinal bleed over five years, the estimated number needed to treat (NNT) for routine proton pump inhibitor (PPI) use decreased from 338 for individuals younger than 65 years to 25 for individuals aged 85 years and older.
"Given that half of the major bleeds in patients aged 75 years or older were upper gastrointestinal, the estimated NNT for routine PPI use to prevent such bleeds is low, and co-prescription should be encouraged," the authors write.
One author disclosed financial ties to Bayer.