Cessation of aspirin in older adults not associated with adverse health effects

1. Aspirin cessation in older adults led to increased cardiovascular disease events, though not statistically significant.

2. Aspiring cessation in older adults was not significantly associated with any change in mortality.

Evidence Rating Level: 1 (Excellent)

Study Rundown: A prior randomized, double-blind placebo-controlled primary prevention trial of aspirin demonstrated that aspirin had no benefit for disability-free survival, prevention of cardiovascular disease events, or prevention of incident cancer. These findings were interpreted as being relevant only to aspirin initiation, but there is a gap in knowledge as to understanding the risks and benefits of aspirin cessation among older adults. This study found that aspirin cessation was not significantly associated with any changes in disability-free survival or other clinical outcomes such as dementia, or persistent physical disability, and though statistically insignificant, aspirin cessation did increase cardiovascular disease events. This study was limited by factors such as a gap in continuous exposure for those randomly assigned to aspirin, as well as the study group having reduced statistical power and likely self-selection for tolerance. Nevertheless, these study’s findings are significant, as they demonstrate that aspirin cessation, especially in patients with a large medication burden or clinical history, should be conducted with due caution as the cessation of aspirin might lead to adverse health outcomes among older adults.

Click to read the study in AIM

Relevant Reading: Does Stopping Aspirin Differ Fundamentally From Not Starting Aspirin in the Primary Prevention of Cardiovascular Disease Among Older Adults?

In-Depth [randomized subgroup analysis]: This subgroup analysis utilized the Aspirin in Reducing Events in the Elderly (ASPREE) randomized trial. Patients who reported taking aspirin 2 or more days per week at enrollment were eligible for the study. Patients who were younger than 70 years and did not report taking aspirin 2 or more days per week were excluded from the study. The primary outcome measured was a composite of all-cause mortality, incident dementia, or persistent physical disability. Outcomes in the primary analysis were assessed via Cox proportional hazards regression with additional subgroup analyses based on age, race, and years of pretrial aspirin exposure. Based on the analysis, evidence of increased risk for the primary outcome for aspirin cessation was statistically insignificant. Overall, 13.8% of participants in the aspirin cessation group and 11.1% in the continuation group experience the primary endpoint, with a hazard ratio for cessation versus continuation of 1.28 (95% confidence interval [CI], 0.98 to 1.68). Additionally, although not statistically significant, aspirin cessation increased cardiovascular disease events among those who had reported taking aspirin for 5 years or longer. Age also had no impact on the effect of aspirin cessation. In conclusion, this study demonstrated that aspirin cessation was not statistically associated with any changes in all-cause mortality, dementia, or physical disability, though the reduced statistical power of this study limits the definitive conclusions that this study can draw. Nevertheless, these results suggest that prior to aspirin cessation, careful consideration of the patient’s medication and the clinical burden should be conducted.

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