Aspirin 'major bleed' warning for over-75s

People over 75 taking daily aspirin after a stroke or
 heart attack are at higher risk of major - and sometimes
 fatal - stomach bleeds than previously thought, research in the Lancet shows.

Scientists say that, to reduce these risks, older people
 should also take stomach-protecting PPI pills.

But they insist aspirin has important benefits - such as preventing heart attacks - that outweigh the risks.

And they warn that stopping aspirin suddenly can be
 harmful.

Anyone with concerns should speak to a doctor
 before considering changing medication, they say.


'Lifelong pills'

Doctors generally prescribe daily aspirin for life after 
a person has a stroke or heart attack to help prevent 
more attacks.

But researchers have known for some time that aspirin 
can increase the risk of stomach bleeds.

Until now, most research involved people under 75,
 showing that the risk of serious bleeds was low in this 
group.

But with around half the people on lifelong aspirin in
 the UK now over 75, researchers at Oxford University
 decided to find out whether the benefits still outweigh the risks in this group.

Their study followed 3,166 patients who had previously
 had a stroke or heart attack and were prescribed aspirin or similar blood-thinning drugs.

They found that, for patients aged under 65, the annual
 rate of disabling or fatal bleeds was less than 0.5% (around one person in every 200 people taking the medication).

Meanwhile, for people aged 75 to 84, this rose to three
 people having major bleeds in every 200.

And the risks of fatal or disabling bleeds continued to 
increase with age.

Lead researcher Prof Peter Rothwell said: "Our new 
study gives us a much clearer understanding of the size
 of the increased risk and the severity and consequences of bleeds in over-75s.

"Our findings raise questions about the balance of 
risk and benefit of long-term daily aspirin use in people 
aged 75 or over if a PPI drug is not co-prescribed."

Dr Tim Chico, heart specialist at the University of 
Sheffield, described the work as a well-conducted study.

He said: "Although bleeding is a well-recognised side
-effect of aspirin, this drug is still seen by many people as harmless, perhaps because of how easily it can be bought over the counter."

Meanwhile, GP leader Prof Helen Stokes-Lampard, said: 
"The study does reassure us that, in most cases, aspirin
is still the most appropriate course of treatment for patients, but highlights the importance of managing its use carefully and effectively and that some patients may require additional medication to protect them."

But she added: "It is helpful that the researchers
suggest action to mitigate this risk - the prescription of
 a PPI as a secondary drug - but this does raise a number of health implications.

"It will continue to be necessary to make decisions on
 a case-by- case basis, considering the patient's unique circumstances and medical history."

Current guidelines in the UK recommend people at
 "high risk" are given a PPI (proton pump inhibitor) drug
 which protects the stomach, along with aspirin therapy.

But who exactly is at high risk is not specified. And Prof Rothwell says the majority of over-75s are not prescribed
 the drug.


I take aspirin every day - should I be panic ?

Prof Helen Stokes-Lampard, head of the Royal College
 of GPs, says: "Patients who regularly take aspirin either as prescribed by their doctor or self-medicated, should not
 panic as a result of this research.

"But if they are concerned about taking the drug 
regularly, over a long period of time, they should make 
a non-urgent appointment with their GP, or discuss
 this with their local pharmacist."


Why shouldn't aspirin be stopped suddenly?

Stopping aspirin suddenly has been shown to have a
 rebound effect - increasing the chance of heart attack,
 TIA and stroke for weeks after the pill is stopped.

Anyone who is concerned must discuss it with their
 doctor. If stopping is advised, doctors will discuss 
cutting down pills gradually.


What about stomach protection for people under-75 given daily aspirin after strokes and heart attacks?

For this group a number of previous studies show that
 the risk of major bleeding is low. Prof Rothwell says he
 would not recommend a stomach-protecting drug for 
people of this age.

But researchers recommend anyone taking the drug
 should review the decision with their doctor every three
 to five years, to make sure individual circumstances are
 taken into account.

Do stomach-protecting PPI drugs carry any risks?

All drugs have risks and benefits and the decision
 to take them must be made after weighing these up for
 the individual. When it comes to PPIs the side-effects can include flatulence, bloating and sometimes stomach infections.