A recent study, published in The Lancet, has recommended that patients over the age of 75, receiving aspirin-based antiplatelet treatment, be co-prescribed proton-pump inhibitors (PPIs) to reduce the incidence of upper gastrointestinal bleeding.
Aspirin
The prospective, population-based cohort study analysed the data from patients who were included in the Oxford Vascular Study between 2001 and 2012 and were receiving antiplatelet treatment (mainly aspirin based) without routine PPI use after suffering a first transient ischaemic attack, ischaemic stroke or myocardial infarction. After exclusions, the study population was 3,166 patients, of which half (1,582) were over the age of 75.
It was found that there was an increased risk of bleeding as age of the patient increased, in particular for fatal bleeds. In the group of patients aged 75 years or older, the researchers found that major upper gastrointestinal bleeds were, for the most part, disabling or fatal and were more numerous than intracerebral haemorrhages that were disabling or fatal.
As a result of their findings, the team determined that age was a suitable consideration to define patients as high-risk of encountering an upper gastrointestinal bleed and as such, would be an appropriate threshold to commence treatment with the stomach protecting PPI therapy. They specified that the co-prescription of PPIs with antiplatelet therapy should be considered for secondary prevention guidelines relating to upper gastrointestinal bleeds in over-75s.
Speaking to the BBC, lead researcher Professor Peter Rothwell, Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, said: “Our new study gives us a much clearer understanding of the size of the increased risk and the severity and consequences of bleeds in over-75s. Our findings raise questions about the balance of risk and benefit of long-term daily aspirin use in people aged 75 or over if a PPI drug is not co-prescribed.”
However, as a final note, the researchers stated that further work is required to clarify the best way to identify ‘high-risk’ patients, how to reduce the risk of other bleeds (those that are not in the upper gastrointestinal region) and the benefit-risk balance for long-term treatment in relation to the age of the patient in primary and secondary preventative care.