An analysis of the ASPREE trial showed that low-dose aspirin use may increase anemia by 20% and reduce ferritin levels in older adults. This study suggests that occult blood loss, rather than a major bleeding event, may be the primary cause.
Analysis of the ASPREE (ASPirin in Reducing Events in the Older Adults) Trial Finds Low-Dose Aspirin Use Increases the Incidence of Anemia by 20% and Lowers Ferritin (Blood Iron) Levels in Healthy Older Adults became. This suggests that hemoglobin levels in elderly patients taking aspirin should be monitored regularly. The analysis was published in the June 20th issue of the journal. Annals of Internal Medicine.
Aspirin use in older adults in the United States
About half of older Americans report using aspirin prophylactically. However, aspirin use can cause heavy bleeding, especially in the gastrointestinal tract. Although the overt bleeding risk from aspirin use is well documented, only a handful of studies have investigated the effects of aspirin on anemia, especially in older age groups.
ASPREE exam: methodology and results
Researchers at Monash University in Melbourne conducted a retrospective analysis of the ASPREE randomized controlled trial. The trial included 19,114 participants aged 70 and older who were randomized to receive either 100 mg aspirin daily or placebo. Hemoglobin levels were measured annually and ferritin was assessed at the start of randomization and after 3 years. Data showed a 23.5% risk of developing anemia in the low-dose aspirin group. This risk was accompanied by a small but larger reduction in mean hemoglobin in the aspirin group and a more pronounced reduction in ferritin levels.
Potential causes and effects
Clinically significant bleeding events did not explain the overall difference in anemia events or ferritin lowering observed in the ASPREE trial. Rather, occult blood loss is likely the primary cause, as suggested by the abrupt decline in ferritin in aspirin users.
Reference: “Effect of low-dose aspirin and placebo on the incidence of anemia in the elderly: A secondary analysis of aspirin in reducing events in a geriatric trial” by Zoe K. McQuilten, MB, BS, PhD, Le Thi Phuong Thao PhD, Sant-Rayn Pasricha, MB, BS, PhD, Andrew S. Artz, MD, MS, Michael Bailey PhD, Andrew T. Chan, MD, MPH, Harvey Jay Cohen, MD, Jessica E. Lockery, MB, BS, PhD, Anne M. Murray, MD, MSc, Mark R. Nelson, PhD, MB, BS, PhD, Hans G. Schneider, MD, Rory Wolfe, PhD, Robin L. Woods, PhD, Erica M. Wood, PhD, MB, Science and John J. McNeill, MB, BS, PhD, 20 June 2023, Annals of Internal Medicine.
DOI: 10.7326/M23-0675
