Insufficient Evidence on Risks of Aspirin Cessation in Older Adults

There is insufficient evidence to determine if aspirin cessation increases the risk of death, dementia, and disability in older adults, according to results of a post hoc analysis.

To determine the impact of ceasing aspirin therapy on disability-free survival and other outcomes, a research team conducted a post hoc analysis of data from participants who regularly took aspirin at least 2 days per week, as part of the Aspirin in Reducing Events in the Elderly (ASPREE) trial. ASPREE was a randomized, double-blind, placebo-controlled trial of aspirin for primary prevention in older persons at least 70 years old who lived in the community.

The researchers compared participants who were randomized to cease taking aspirin with those who were randomized to continue taking aspirin. The primary outcome was a combination of all-cause mortality, incident dementia, or persistent physical disability. Secondary outcomes were all-cause mortality, major adverse cardiovascular (CV) events, any CV event, major hemorrhage, and incident cancer. They completed subgroup analyses by age (<75 yr vs ≤75 yr), race (White vs non-White), and years of aspirin exposure before the trial (≤5 yr vs ≥5 yr).

Nearly 5 years of follow-up produced weak evidence of increased risk for the composite primary outcome from aspirin cessation, and only in nonWhite participants; 116 of 841 participants in the cessation group (13.8%) experienced the primary endpoint (29.8/1000 person-years [P-Y]), compared with 97 of the 873 participants (11.1%) in the continuation group (23.4/1000 P-Y) (cessation vs continuation [HR=1.28, 95% CI, 0.98 to 1.68]).

Aspirin cessation increased CV disease events among those who had taken aspirin for ≥5 years, and age did not alter the effect of aspirin cessation.

“[Because] the analyses are likely underpowered, our findings cannot conclusively demonstrate clear harm or benefit of either cessation or continuation of aspirin in older adults,” the researchers commented. “[A] pragmatic recommendation may be to consider aspirin cessation in those with a large medication burden with due caution.”

—Ellen Kurek

Reference:

Nelson MR, Polekhina G, Reid CM, et al. Safety of ceasing aspirin used without a clinical indication after age 70 years: a subgroup analysis of the ASPREE randomized trial. Ann Intern Med. Published March 15, 2022. doi:10.7326/M21-3823