Low-dose aspirin may increase anemia risk in healthy older adults

Monash University | 06-19-2023
Older adults, elderly adults
Low-dose aspirin may increase anemia risk in healthy older adults. Credit: © photography33 – Depositphotos

A new study analyzing data from the landmark ASPREE trial has found that prolonged daily aspirin use increases the risk of anemia by 20 percent in people mostly aged 70 and over.

The results have prompted researchers to suggest that regular monitoring for anemia be considered for older adults who take low-dose aspirin and to discuss any concerns about their health or medications with their GP.

Globally, an estimated 30 percent of people aged 75 years or older are anemic. Anemia in the elderly is most commonly attributed to iron deficiency (15-20 percent), medical comorbidities (including renal impairment) and/or inflammation (e.g. anemia of chronic disease). The cause is unknown in about a third of cases. While the risk of overt bleeding due to aspirin has been established by research, few studies have measured the effect of aspirin on anemia.

The Monash University-led study, published in Annals of Internal Medicine, followed 18,153 initially healthy older adults in Australia and the USA and recorded incidents of anemia over an average of 4.7 years.

The risk of developing anemia was found to be 20 percent higher in the aspirin group compared to those in the placebo group.

It was the largest study to investigate anemia in older people as part of a randomized controlled trial, ASPREE (ASPirin in Reducing Events in the Elderly) – with half the participants taking a placebo and the other half a daily low dose (100mg) of aspirin.

Anemia is commonly experienced by older adults, potentially affecting overall function and increasing fatigue, disabilities, depressive symptoms, and cognitive problems.

In addition to a higher risk of anemia, blood tests revealed a faster decline of hemoglobin and reduced ferritin (a protein that carries iron) levels in the aspirin group compared to the placebo group.

Lead author, Associate Professor Zoe McQuilten from Monash University’s School of Public Health and Preventive Medicine, said while bleeding was a known side-effect of aspirin, few previous studies had looked at the effect of prolonged aspirin use on the progressive development of anemia in older adults.

“This study gives a clearer picture of the additional risk of becoming anemic with aspirin use and the impact is likely to be greater in older adults with underlying diseases, such as kidney disease,”  Associate Professor McQuilten said.

Associate Professor McQuilten said the new data gave doctors insight into the risk of anemia from prolonged aspirin use by their older patients. “Older adults are more likely to become anaemic generally and now doctors can potentially identify patients at higher risk of developing anemia,” she said.

Associate Professor McQuilten urged patients to follow the advice of their doctor about their daily use of aspirin. She cautioned that for some older adults, aspirin was recommended as a valuable therapy to prevent recurring heart attacks or stroke. “Patients should not change their aspirin regimen without speaking to their GP,” she said.


Materials provided by Monash University. Content may be edited for clarity, style, and length.


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