Abstract
A careful assessment of benefits and harms is required to assess suitability of aspirin as a prophylactic public health measure. However, comprehensive population-level data on harms are lacking. We collected and synthesized age and sex-specific data on harms relevant to aspirin use in average-risk individuals aged 50 years or older. We conducted systematic literature searches to identify baseline rates of gastrointestinal (GI) bleeding, peptic ulcer, major extra-cranial bleeding, and case-fatality rates due to GI bleeding or peptic ulcer in general population. The magnitude of aspirin-associated increase, the prevalence and attributable risk of Helicobacter pylori infection on these events in aspirin users was also assessed. Baseline rates of major extracranial bleeding events and GI complications increase with age; an almost threefold to fourfold increase is observed from age 50–54 to 70–74 years. Low or standard-dose aspirin use increases GI bleeding events by 60 % leading to an annual excess of 0.45 and 0.79 GI bleeding events per 1,000 women and men aged 50–54 years respectively. 5–10 % of major GI complications are fatal; a clear age dependence—higher fatality in older individuals, is seen. Eradication of H. pylori infection before aspirin use could reduce the incidence of upper GI complications by 25–30 %. GI complications are increased by about 60 % due to aspirin use but are fatal only in a very small proportion of individuals younger than 70 years of age. Major bleeding events that are comparable in severity to cancer or CVD, are infrequent. Screening and eradication of H. pylori infection could substantially lower aspirin-related GI harms.
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Abbreviations
- ACS:
-
American Cancer Society
- ATT:
-
Antithrombotic Trialists
- BDT:
-
British Doctors’ Trial
- BHF:
-
British Heart Foundation
- CRUK:
-
Cancer Research UK
- CVD:
-
Cardiovascular disease
- HPFS:
-
Health Professionals Follow-up Study
- HTA:
-
Health Technology Assessment
- GI:
-
Gastrointestinal
- ISCaP:
-
International Society of Cancer Prevention
- LGIB:
-
Lower gastrointestinal bleeding
- NANSAIDs:
-
Non-aspirin NSAIDs
- NHS:
-
Nurses’ Health Study
- ONS:
-
Office of National Statistics
- PHS:
-
Physicians’ Health Study
- SAH:
-
Sub-arachnoid haemorrhage
- UGIB:
-
Upper gastrointestinal bleeding
- UGIC:
-
Upper gastrointestinal complications
- USPSTF:
-
U.S. Preventive Services Task Force
- WHS:
-
Women’s Health Study
- 1,000-PY:
-
1,000 Person years
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Acknowledgments
This study was a part of broader review of prophylactic use of aspirin. The review was sponsored by International Society of Cancer Prevention (ISCaP), Cancer Research UK (CRUK), British Heart Foundation (BHF) and American Cancer Society (ACS) and received funding from CRUK, BHF and ACS. Sponsors and funding sources had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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JC: Member of the Bayer advisory board. MAT: None.
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Thorat, M.A., Cuzick, J. Prophylactic use of aspirin: systematic review of harms and approaches to mitigation in the general population. Eur J Epidemiol 30, 5–18 (2015). https://doi.org/10.1007/s10654-014-9971-7
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DOI: https://doi.org/10.1007/s10654-014-9971-7