Real-world data links low-dose aspirin use to increased anemia risk among older adults
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Key takeaways:
- Older adults exposed to low-dose aspirin had a higher risk for anemia and hematinic deficiency compared with those who were not exposed.
- Anemia among older adults occurred independently of major bleeding.
Low-dose aspirin use was significantly associated with an increased risk for anemia among older Danish adults in a real-world setting, according to a study published in European Heart Journal – Quality of Care and Clinical Outcomes.
As Healio previously reported, a post hoc analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial revealed that daily intake of low-dose aspirin was linked to an increased incidence of anemia among healthy older adults.
“While data from the ASPREE trial have contributed with valuable evidence, there remains a notable gap in our understanding of the real-world impact of low-dose aspirin for both primary and secondary prevention [of CVD] in relation to the risk of anemia,” Maria Antonietta Barbieri, a PhD student in the department of drug design and pharmacology at the University of Copenhagen in Denmark and the department of clinical and experimental medicine at the University of Messina in Italy, and colleagues wrote.
To address this gap, Barbieri and colleagues conducted a registry-based cohort study to assess risk for developing anemia among older Danish adults exposed to low-dose aspirin.
They used several Danish registers to identify 313,508 older adults (median age, 73.1 years; 57.7% women) who redeemed their first low-dose aspirin prescription (75 mg or 100 mg) for the primary or secondary prevention of CV events between 2008 and 2013. Of this cohort, 19.1% were exposed to low-dose aspirin during the study period, and the remaining 80.9% were identified as nonusers.
The primary outcome was incidence of anemia — defined as hemoglobin levels less than 12.9 g/dL for men and less than 11.3 g/dL for women — or incidence of hematinic deficiency based on initiation of antianemic treatment during the 5-year follow-up. Secondary outcomes included the occurrence of major bleeding and trend of hemoglobin during follow-up.
The researchers stratified adults who developed anemia as having mild (10 g/dL to lower limit of normal), moderate (8 g/dL-9.9 g/dL) or severe (< 8 g/dL) anemia.
Overall, anemia occurred in 5.9% of adults who were exposed to low-dose aspirin compared with 3.1% of adults who were not exposed (incidence rate ratio [IRR] = 7.89; 95% CI, 7.58-8.21), according to the researchers.
Specifically, mild anemia occurred in 3.9% of adults who were exposed to low-dose aspirin compared with 2.2% of adults who were not exposed, whereas severe anemia occurred in 1.3% of adults who were exposed to low-dose aspirin compared with 0.6% of adults who were not exposed.
Among adults treated with low-dose aspirin who developed anemia, the median reduction in hemoglobin levels was 0.44 g/dL for those with mild anemia, 2.15 g/dL for those with moderate anemia and 13.93 g/dL for those with severe anemia, according to the study
The researchers observed a similar trend for ferritin levels among adults exposed to low-dose aspirin who developed anemia, with a median reduction of 37 µg/L for those with mild anemia, 41 µg/L for those with moderate anemia and 44 µg/L for those with severe anemia.
Additionally, they found that 9.6% of adults exposed to low-dose aspirin had a hematinic deficiency compared with 3.7% of those who were not exposed (IRR = 9.11; 95% CI, 8.81-9.41), and 10.6% of adults exposed to low-dose aspirin experienced major bleeding compared with 3.7% of those who were not exposed (IRR = 10.56; 95% CI, 10.23-10.9).
Barbieri and colleagues noted that only 21.5% of adults who experienced anemia also experienced bleeding, and posited that most anemia events were independent of major bleeding.
“These findings underscore the significance of continuous, long-term monitoring for individuals prescribed low-dose aspirin, allowing a more comprehensive understanding of the evolving risks of anemia associated with this medication,” the researchers wrote. “Health care providers should carefully weigh the risks and benefits of low-dose aspirin, particularly in older populations, and diligently monitor the occurrence of anemia. This proactive approach is essential to strike the optimal balance between potential advantages and associated risks.”
The researchers acknowledged several study limitations, including its observational nature, which creates the potential for biases.
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