Daily Aspirin Challenged in Primary Stroke Prevention in Older People. Secondary Analysis of a Randomized Clinical Trial (ASPREE)

Low-dose aspirin has been widely used for primary and secondary prevention of stroke.
The balance between potential reduction of ischemic stroke events and increased intracranial bleeding has not been established in older individuals.
А report on the secondary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) randomized, double-blind, placebo-controlled trial of daily low-dose aspirin was published July 26 in JAMA Network Open.
Participants were older adults free of symptomatic cardiovascular disease. Among 19 114 older adults (10 782 females [56.4%]; median [IQR] age, 74 [71.6-77.7] years), 9525 individuals received aspirin and 9589 individuals received placebo. Recruitment took place between 2010 and 2014, and participants were followed up for a median (IQR) of 4.7 (3.6-5.7) years.
Aspirin did not produce a statistically significant reduction in the incidence of ischemic stroke (hazard ratio [HR], 0.89; 95% CI, 0.71-1.11). However, a statistically significant increase in intracranial bleeding was observed among individuals assigned to aspirin (108 individuals [1.1%]) compared with those receiving placebo (79 individuals [0.8%]; HR, 1.38; 95% CI, 1.03-1.84). This occurred by an increase in a combination of subdural, extradural, and subarachnoid bleeding with aspirin compared with placebo (59 individuals [0.6%] vs 41 individuals [0.4%]; HR, 1.45; 95% CI, 0.98-2.16). Hemorrhagic stroke was recorded in 49 individuals (0.5%) assigned to aspirin compared with 37 individuals (0.4%) in the placebo group (HR, 1.33; 95% CI, 0.87-2.04).
This study found a significant increase in intracranial bleeding with daily low-dose aspirin but no significant reduction of ischemic stroke.
Senior author John J. McNeil, PhD, observed, "question whether there's much rationale for prescribing it for a long-term benefit, or benefit that might not become apparent for years afterward, when there's so many short-term risks that you have to overcome".

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