BBC News: "Aspirin 'major bleed' warning for over 75s"

This BBC news headline refers to a new study looking at the side effects of aspirin in people of different ages taking it over a number of years. A rare side effect is internal bleeding. This study confirmed that older people (those over 75) are more likely to experience bleeding and showed that it is more likely to be serious in this age group. They also confirmed that, in the under 75s, few people experience bleeding.

The study recruited people who were prescribed aspirin by their GP following a heart attack or stroke. This group includes people who are more likely to experience bleeding with aspirin, such as those with a history of stomach ulcers or kidney failure. These people are not able to take part in the Add-Aspirin trial. Additionally, older people (those aged over 75) joining the trial will not be prescribed the higher dose of aspirin.

When bleeding occurs with aspirin, it is most commonly in the stomach and an additional medication (a proton pump inhibitor, PPI) can be prescribed alongside aspirin to offer some protection against this. However, this is not currently recommended except for specific groups of people who are more likely to experience bleeding. In the Add-Aspirin trial, the study doctor can decide for each individual whether or not to prescribe a PPI, and they may consider this for older patients.

The Oxford study has also highlighted the importance of blood pressure control, since those with high blood pressure are more likely to experience bleeding in the brain. Participants in the Add-Aspirin trial have their blood pressure checked regularly for this reason. 

This new research has also confirmed that, particularly for younger people (<75 years), the benefits of taking aspirin following a heart attack or stroke are likely to outweigh the risks of serious side effects. For those taking part in the Add-Aspirin trial, we hope to show combined benefits of aspirin, since it has the potential to both delay cancer recurrence and protect against heart disease. Any participant who is concerned should contact their study doctor.    

The study was published in the Lancet journal - the paper can be accessed here.