Heart Health

Taking an aspirin might be dangerous, so let's add another pill???

Published 7.9.2017
I'm going to begin this piece with my oft stated disclaimer: I am not any sort of medical professional, and I don't play one on the internet. Nothing written here should be construed in any way as medical advice.

Aspirin can cause serious bleeding and the risk increases as you age. As noted above, I’m no doctor, but I don’t know that taking another pill is the answer. Why not just stop taking the damn aspirin daily? What’s the higher risk?

Lifelong aspirin gets prescribed after a vascular blockage event (which is not the medical term for it but is descriptive). Bodies changes as they age, so it should not surprise that the reaction to a given drug might change over time. The real question is whether there was ever any reason to take the aspirin over the long term. Short term benefit is documented, but the long term benefit was merely assumed. Now there is evidence that over the very long term or for the very elderly (85 and older) a new risk of gastrointestinal bleeding is created.

Older people who take aspirin to prevent a recurrent cardiovascular event should take a proton-pump inhibitor to lower their risk of serious bleeding complications, say the authors of a new study published in the Lancet.

After a transient ischemic attack, ischemic stroke, or myocardial infarction, aspirin is commonly taken to prevent a recurrent event. Although aspirin is taken by 40% to 60% of people over 75, the studies demonstrating the safety of aspirin were performed in trials with younger participants.

Researchers in Oxford, led by Peter Rothwell, MD, PhD, followed 3,166 people taking antiplatelet therapy, predominantly aspirin, following a CV event. About half the patients were over the age of 75. The risk of major bleeding, including fatal bleeds and major upper GI bleeds, increased dramatically with age. Further, a higher proportion of GI bleeding events were disabling or fatal in older patients, and these events outnumbered disabling or fatal intracerebral hemorrhage.

The actual paper is here.

My non-medical first thought is, well, stop taking the aspirin and see what happens. Worth every penny you paid to read it.

Alcohol ablation works in younger HOCM (hypertrophic obstructive cardio myopathy) also called HCM (hypertrophic cardio myopathy) alcohol patients. Younger in this case means in their 50s. It also worked for my 78 year old mother in-law, which is why this finding interested me.

Alcohol septal ablation (ASA) was safe and effective for younger obstructive hypertrophic cardiomyopathy (HCM) patients in a study with long-term data, leading investigators to call for a broadened indication for the procedure.ASA patients ages 50 years and younger had lower periprocedural mortality (0.3% versus 20%, P=0.03) and pacemaker implantation rates (8% versus 16%, P<0.001) than those of their peers over 65, reported Max Liebregts, MD, of St. Antonius Hospital in the Netherlands, and colleagues.

The younger patients shared the same 1% annual odds of adverse arrhythmic events with older groups (P=0.90). However, functional recovery was more likely in the younger group. During 5.4 years' follow-up, 95% of young patients studied reached New York Heart Association functional class I or II, compared with 81% among those 65-years-and-older (P<0.001), according to the study published in the June 12 issue of JACC: Cardiovascular Interventions.

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