Patients taking low dose aspirin for stroke prevention have brain bleed risk

A Monash University-led study has concluded the risk of a brain bleed particularly in older people who are often exposed to falls and knocks on the head, outweighs any potential benefit of reducing the risk of strokes in healthy older adults who take daily low dose aspirin.

However, the researchers have stressed that people taking low dose aspirin should not stop without consulting their GP.

Researchers drew on data from ASPREE (ASPirin in Reducing Events in the Elderly), a primary prevention aspirin trial involving more than 19,000 initially healthy older adults, mostly over the age of 70, the vast majority in Australia and the rest in the USA.

Primary prevention involves actions to preserve health and prevent adverse health events. Secondary prevention interventions are taken after a health event to avoid it happening again.

The participants, who did not have known cardiovascular disease when they entered the study, were randomly assigned 100 mg daily aspirin or placebo tablet for an average of five years.

A secondary analysis study found no statistically significant difference in the incidence of ischemic stroke - the most common type of stroke, caused by a blockage in vessels carrying blood to the brain - between the aspirin and placebo group.

Overall, strokes were reported in 4.6 per cent of the aspirin group and 4.7 per cent in the placebo group.

While the number of brain bleeds was small, bleeding events were 38 per cent higher in those who took aspirin compared to placebo.

"These findings suggest that low-dose aspirin may have no role for the primary prevention of stroke and that caution should be taken with use of aspirin in older persons prone to head trauma e.g. from falls," the researchers wrote.

Senior Author Professor John McNeil said "Although the overall incidence of bleeding was not common, it highlighted another risk of low-dose aspirin, especially relevant to older people susceptible to head trauma," Professor McNeil said.

"These findings do not apply to older adults taking aspirin on medical advice, such as after a heart attack and ischaemic stroke. In secondary prevention, the balance of risks and benefits generally favours aspirin. It's important to consult with your GP before making any changes to your medicine intake."

First author and Director of Stroke Services at Alfred Health, Professor Geoffrey Cloud, said people could reduce their risk of stroke by living a healthy lifestyle.

"Older people concerned about reducing their risk of having their first stroke should not take daily aspirin without their doctor's advice but instead concentrate on modification of lifestyle risk factors and blood pressure control," he said.

About ASPREE

The Monash University-led ASPREE trial was the first trial to show that aspirin did not prolong healthy lifespan in initially healthy older individuals, mostly aged 70 and older.

For more information about ASPREE, click here.