The risk of long-term aspirin use causing major bleeding and death is higher than previously thought, with over-75s particularly vulnerable, a study suggests. The examination should do for every three to five years in very elderly patients who take aspirin.
To find out more, Peter Rothwell from the University of Oxford led a team of researchers in examining medical records for more than 3,000 patients who had had a stroke or heart attack, and taken daily aspirin or its equivalent for many years.
Fortunately, there is a way to offset the risk of bleeding from aspirin: by prescribing a proton pump inhibitor, a class of drugs that reduces the amount of acid, which can contribute to bleeding, produced by the stomach.
Researchers emphasized that the findings did not mean that older patients should stop taking aspirin.
Worryingly, this advice was based on trials involving younger patients for just two to four years.
Anywhere from 40% to 60% of older people take daily aspirin to prevent a heart attack or stroke. Next, coming to the following decade, 314 patients admitted to hospital in case of bleeding.
For patients under 65, the annual rate of disabling or fatal bleeding was less than 0.5 per cent, rising to 1.5 per cent in those aged 75 to 84 and almost 2.5 per cent for patients aged 85 or older.
The annual rate of life-threatening or fatal bleeds was less than 0.5 per cent, for patients under 65, 1.5 per cent for those aged 75 to 84 and nearly 2.5 per cent for patients aged 85 or over, "The Guardian" reported.
But those above the age of 75 should also be prescribed a proton pump inhibitor which would reduce bleeding risks by up to 90 per cent.
The proportion of survivors for whom a bleed resulted in a new, or sustained increase in disability rose from 3% for people aged under 75, to 25% for people aged over 75. Heartburn medication would allow people 75 years and older to keep the precautionary advantages of aspirin while averting its risky side-effects, as was reported in the medical journal the Lancet.
Dr Tim Chico, reader in cardiovascular medicine and consultant cardiologist at Sheffield University, said: "Prescription of any drug is a balance between the benefits of the medication against its risks, and aspirin is no different".
Meanwhile, other studies have shown a causal link between antiplatelet treatment and upper gastrointestinal bleeding, but estimates on the size of the risk vary widely.
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".
Even among those who are without any history of heart problems or stroke, risk of gastrointestinal bleeding increases with age for those using aspirin other research has revealed.
The majority of these were in people older than 75.
The consumption of aspirin as a secondary way to prevent heart attack or stroke outweigh the risk of bleeding and hence this person need not worry.
But experts say the risks needed to be evaluated.
The painkiller is often prescribed to help prevent heart disease and strokes in those patients deemed to be most at risk.