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Low-dose aspirin use increases intracranial hemorrhage risk
Patients with no CVD symptoms who took 100 mg or less of aspirin daily were at increased risk for intracranial hemorrhage, according to findings recently published in JAMA Neurology.
The findings come about 1 month after the American College of Cardiology and American Heart Association updated its guidelines, stating that most patients should not use aspirin as a mechanism for the primary prevention of CVD.
In the new study, Wen-Yi Huang, MD, PhD, of the department of neurology at Chang Gung Memorial Hospital in Taiwan, and colleagues acknowledged the trials that led to the recent ACC/AHA recommendations.
They wrote that “of the various major bleeding events related to the use of aspirin, intracranial hemorrhage is a special concern because it is strongly associated with a high risk of mortality and poorer health over a lifetime.”
These researchers identified 13 randomized clinical trials consisting of 134,446 patients who used 100 mg or less of aspirin daily for primary CVD prevention.
Huang and colleagues found that low-dose aspirin, vs. control, was associated with an increased risk for any intracranial bleeding (RR = 1.37; 95% CI, 1.13-1.66) and possibly the greatest relative risk increase for subdural or extradural hemorrhage (RR = 1.53; 95% CI, 1.08-2.18) and less for subarachnoid and intracerebral hemorrhages. In addition, Asian patients and those with low BMI who used low doses of aspirin were at even higher risk.
“The absolute magnitude of these adverse effects is modest, but clinically relevant. Given that the many individuals in the general population have a very low risk of atherosclerotic cardiovascular events, if low-dose aspirin is given universally, adverse outcomes from intracranial hemorrhage may outweigh the beneficial effects of low-dose aspirin,” Huang and colleagues wrote.
“Because the benefits of low-dose aspirin for primary prevention of cardiovascular events are not well established, and the outcomes of intracranial hemorrhage are often catastrophic, these findings suggest caution regarding using low-dose aspirin in individuals without symptomatic cardiovascular disease,” they concluded. – by Janel Miller
Disclosures: The authors report no relevant financial disclosures.