Study: Benefits of Daily Aspirin Outweigh Gastrointestinal Risk

Although aspirin use increases the risk of gastrointestinal (GI) bleeding, the overall risk of fatal bleeding is very low, and should not limit the use of low-dose aspirin for the reduction of incidence of and mortality from heart disease and cancer, according to a recent study.

Although aspirin has been shown to lower mortality from vascular disease and cancer, its wider adoption is “seriously impeded by concerns of GI bleeding,” according to the authors.

They noted that the GI bleeding that occurs with low-dose aspirin use is normally an acute event followed by full recovery, and for this reason, evaluation of the risk-benefit balance of aspirin use should be based on fatal adverse events, rather than incidence of bleeding.

They conducted a systematic literature review, identifying 11 randomized trials dealing with aspirin use in which total GI bleeding events and fatal bleeding events were reported.

Overall, the relative risk of major incident GI bleeding in individuals taking low-dose aspirin was 1.55, and the risk of aspirin-attributable bleeding being fatal was 0.45. In all individuals taking aspirin, there was not a significant increase in the risk of fatal bleeding, compared with those not taking aspirin.

“The undesirable effect of prophylactic aspirin which is of a severity comparable to a vascular disease event or a cancer is a bleed that leads to death, and low-dose aspirin appears to be associated with one death and one disabling hemorrhagic stroke per year in every 10,000 people taking low-dose aspirin,” the researchers concluded.

“These adverse effects of aspirin should be weighed against the reductions in vascular disease and cancer.”

—Michael Potts

Reference:

Elwood PC, Morgan G, Galante J, et al. Systematic review and meta-analysis of randomised trials to ascertain fatal gastrointestinal bleeding events attributable to preventive low-dose aspirin: no evidence of increased risk [published online November 15, 2016]. PLOS ONE.     doi:http://dx.doi.org/10.1371/journal.pone.0166166