Several years ago, when my mom was still alive, I found her suddenly doubled over with abdominal pain. There didn’t seem to be any reason for it since she never had digestive problems before. She was living with me at the time so I was monitoring what she was doing. Then I found out that she was taking a daily aspirin tablet that her doctor had started her on, but nobody told me about it. So she ended up with a gastric ulcer at 85 years of age.

According to a new study, aspirin can do more harm than good in a number of older people. The study was of 19,000 people 65 years old or older who were given low dose aspirin (100mg) or placebo for 4.7 years. The aspirin “did not lower their risks of cardiovascular disease, dementia, or disability and it increased the risk of significant bleeding in the digestive tract, brain, or other sites that required transfusions or admission to a hospital.” New York Times Sept, 2018. Not only was it not helpful, but the aspirin takers had a slightly higher cancer death rate in those who already had the disease1

The New York Times article mentions the fact that 2 other clinical trials found similar results. One published in August 2018 showed no benefit to low risk patients and another indicated that there was some benefit in preventing cardiovascular disease in diabetics but the benefits were outweighed by risk of major bleeding.

So why should people die trying to prevent disease?

First of all, older people tend to have thinner stomachs than younger people. The condition, called atrophic gastritis, is one of the reasons older people are more likely to have s GI bleed from aspirin.
It’s possible that certain people may benefit, but how do we know which ones? That’s a crucial question given that people are dying from this prevention. People should be tested for their risk of clotting vs their risk of bleeding. Generally people with higher risk of clotting would be better candidates.

  1. The first test I would require is the Lp(a) test. This is a protein made in the liver that is an independent risk factor for cardiovascular disease and increases risk of clotting. Levels are determined by genetics.
  2. The second test I would order is Fibrinogen. This is a precursor protein to making fibrin, which makes a blood clot. High levels are associated with a 1.8 fold higher risk of cardiovascular disease.
  3. The third thing I would order in doing this evaluation would be Prothrombin factor 11 and the Factor V leiden (gene tests to see if you have the mutated genes that increase risk of clotting).

If you’re negative on all these, you have a higher risk of bleeding from the aspirin than of getting any protective effect from cardiovascular disease. Unfortunately, this study lumped everyone in together so we didn’t learn much about whether there would be a significant benefit in the group who is most likely to get a clot. Drugs to prevent diseases in healthy people should be very carefully prescribed because of their potential for harm.

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