Daily Low Dose Aspirin Linked to Significantly Higher Anemia Risk for Seniors: Study

While doctors often recommend older patients take daily low-dose aspirin to reduce cardiovascular risks, new research raise concerns that the medications may actually cause older seniors to experience a 20% greater risk of developing anemia.

In a report published in the Annals of Internal Medicine on June 20, researchers from New Zealand and Australia outlined the findings of a randomized controlled trial, known as the Aspirin in Reducing Events in the Elderly (ASPREE) study, which included 19,000 healthy adults aged 70 years or older in the United States and Australia.

The study compared the daily use of 100 mg of aspirin to a daily placebo, taking blood samples to measure hemoglobin and iron levels at the start of the study and again three years into the study.

Aspirin Anemia Risks

Hemoglobin is a protein in the blood that contains iron and carries oxygen throughout the body. Low levels of hemoglobin can cause anemia, which can lead to fatigue, rapid heartbeat, chest pain, headaches, and pounding and whooshing sounds in the ear.

Anemia can cause cardiovascular problems like congestive heart failure to worsen, and it can lead to cognitive impairment and depression.

Overall, the findings indicate more people taking aspirin suffered anemia than in the placebo group. In the aspirin group, there were 51 anemia events per 1,000 person-years, compared to 43 events per 1,000 in the placebo group.

More people in the aspirin group had low iron levels, less than 45 mg/L by the three-year mark. Participants in the aspirin group also had a greater overall decline of iron, by 11.5%, compared with the placebo group.

Additionally, hemoglobin levels declined 3.6 g/L every five years in the placebo group, while the aspirin group experienced a steeper decline of 4.2 g/L per 5 years.

Daily Low-Dose Aspirin Recommendations

Daily low-dose aspirin is often recommended for patients at risk of cardiovascular conditions, but it can also increase the risk of major bleeding in older patients. The new research indicates that patients taking aspirin face a higher risk of suffering from bleeding events, which can lead to anemia.

A study published in 2022 warned that the practice of taking daily aspirin increases an older person’s risk of falling and being hospitalized.

“Low-dose aspirin increased incident anemia and decline in ferritin in otherwise healthy older adults, independent of major bleeding,” The researchers wrote. “Periodic monitoring of hemoglobin should be considered in older persons on aspirin.”

The U.S. Preventive Services Task Force changed its recommendations for low-dose aspirin for cardiovascular disease prevention in 2022, recommending against the long-time common practice of low-dose aspirin use among adults 60 years and older.

For patients 40 to 59 years old with a higher risk of cardiovascular disease, the agency recommends that doctors evaluate patients and make recommendations on a case-by-case basis when weighing all the benefits and risks for a specific patient and their health history.

Research indicates that, despite new recommendations issued in 2022, many older patients continue to use aspirin on a daily basis.

Prior studies have also shown that older persons taking daily aspirin face a higher risk of bleeding and death from taking low-dose aspirin and often do not lead to cardiovascular benefits.