Low-Dose Aspirin and Stroke Risk in the Elderly

In a primary prevention setting, does long-term, daily low-dose aspirin treatment affect the incidence of stroke or intracerebral bleeding?

In recent times, there has been a lot of talk about the benefits and risks of taking aspirin, even in small doses, to prevent strokes among older individuals.
A clinical trial has shed light on this important topic. Let's break down their findings and understand what they mean for older people's health.

Stroke

A stroke or a brain attack, occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts. In either case, parts of the brain become damaged or die. A stroke can cause lasting brain damage, long-term disability, or even death. Every year, more than 795,000 people in the United States have a stroke.

Aspirin is an antiplatelet agent that has been used in low doses (75-100 mg/d) for the prevention of cardiovascular events. Despite some recent unfavorable findings, it continues to be widely used for primary and secondary prevention of stroke. Its major adverse effect is an increased bleeding tendency. However, the balance between the potential reduction of ischemic stroke events and increased intracranial bleeding has not been established in older individuals.

Clinical Trial

The researchers were curious to understand whether taking a low dose of aspirin daily could help reduce the risk of stroke among healthy older individuals. They also wanted to ascertain whether there was any increased risk of intracranial bleeding associated with aspirin use.

Aspirin is commonly known for its ability to thin the blood, which can make it harder for clots to form. Clots are responsible for many strokes, so the researchers aimed to explore whether this simple and widely available medication could be a game-changer for stroke prevention.

The clinical trial looked at a group of healthy older people. These were individuals who did not have any major health conditions that could put them at an increased risk of stroke. The clinical trial involved 19,114 healthy older adults who were randomly divided into two groups: one group took a low dose of aspirin daily, while the other group did not take aspirin and took a placebo instead. The incidence of ischemic stroke and intracranial bleeding were the main outcomes.

Results

The researchers followed both groups for a significant period of time, carefully observing and documenting any occurrences of stroke or bleeding within their brains (known as intracerebral bleeding). The results were quite interesting.

The group that took low-dose aspirin daily did not show a reduced risk of having an ischemic stroke compared to the group that did not take aspirin. This suggests that aspirin might not have a positive effect in preventing ischemic strokes among healthy older individuals. On the other hand, the same group that took aspirin had a slightly higher risk of experiencing intracerebral bleeding (108 individuals [1.1%] in the aspirin group compared with 79 individuals [0.8%] in the placebo group).

This quantifies a 38% increase in intracranial bleeding resulting from a combination of hemorrhagic stroke and other causes of intracerebral hemorrhage among individuals who were receiving aspirin.

What Does It Mean for You?

For healthy older individuals, this study offers some valuable insights. Taking a low dose of aspirin might not help lower the risk of ischemic stroke. However, the increased risk of intracerebral bleeding is something to be cautious about.

Conclusion

The clinical trial provides us with a clearer picture of how low-dose aspirin can impact the health of healthy older individuals. It shows a lack of potential benefit in reducing ischemic stroke risk, but also highlights the increase in the risk of intracerebral bleeding. Ultimately, the decision to take aspirin should be based on a careful evaluation of your health, in consultation with a medical expert.
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