Low-Dose Aspirin Use in Older Adults Increases Incidence of Anemia

In a post hoc analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) randomized control trial, researchers found that the use of low-dose aspirin in healthy older adults increased the incidence of anemia and decreased levels of ferritin, a protein that stores iron.

Using low-dose aspirin daily increases the risk of major bleeding, but prior to the study, little was known about its effect on iron deficiency and anemia.

In their study, McQuilten and colleagues randomly assigned a total of 19,114 participants aged 70 years or older (or 65 and older for Black and Hispanic participants) to either 100 mg of aspirin daily or placebo. The study participants had their hemoglobin concentration levels measured annually, and their ferritin levels were measured at both baseline and 3 years post-trial in a large subset.

The researchers found an increase in anemia incidence in the aspirin group compared with placebo (51.2 events versus 42.9 events, respectively). Although hemoglobin concentrations declined by 3.6 g/L per 5 years in the placebo group, the researchers observed a steeper decline in the aspirin group (by 0.5 g/L) in the same time period.

In 7139 participants with ferritin measures at baseline and year 3, the aspirin group had a greater decline in ferritin (11.5%) when compared with the placebo group.

Based on their results, the researchers concluded that there should be “periodic monitoring of hemoglobin should be considered in older persons on aspirin.”

Reference:

McQuilten ZK, Phuong Thao LT, Pasricha SR, et al. Effect of low-dose aspirin versus placebo on incidence of anemia in the elderly. Ann Intern Med. 2023;176(7):913-921. doi:10.7326/M23-0675