Annals of Internal MedicineEffect of Low-Dose Aspirin Versus Placebo on Incidence of Anemia in the Elderly

Could the routine use of aspirin in older adults necessitate more careful monitoring of their hemoglobin and ferritin levels?

Aspirin’s role in managing pain and reducing heart attack risk is well-known in the medical community. However, new insights into its potential effects on hemoglobin and ferritin concentrations could modify how physicians prescribe this common medication.

Key Points:

• The study conducted a post hoc analysis of the ASPREE (ASPirin in Reducing Events in the Elderly) randomized controlled trial, which involved community-dwelling persons aged 70 years or older, including Black and Hispanic individuals aged 65 or older.
• The daily intake of 100mg of aspirin was associated with a higher incidence of anemia (51.2 events per 1,000 person-years) compared to placebo (42.9 events per 1,000 person-years), with a hazard ratio of 1.20.
• Hemoglobin concentrations declined more significantly in the aspirin group (3.6g/L per 5 years, with an additional decline of 0.6 g/L) than the placebo group.
• In participants with ferritin measures at baseline and after 3 years, the aspirin group showed greater prevalence of ferritin levels less than 45 µg/L at year 3 (13% vs. 9.8%) and a larger overall decline in ferritin by 11.5%.

Additional Points:

• The data did not change significantly when the effects of aspirin were analyzed excluding major bleeding instances.
• The study’s limitation includes the annual measurement of hemoglobin and a lack of data on the causes of anemia.

Conclusion:

• The use of low-dose aspirin in older adults can potentially increase the incidence of anemia and cause a more significant decline in ferritin levels, irrespective of major bleeding incidents.

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Did You Know?
According to a study published in the Journal of the American Geriatrics Society, about 40% of adults aged 75 years and older in the United States regularly use aspirin, often for preventive purposes.