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01-01-2015 | Review

Prophylactic use of aspirin: systematic review of harms and approaches to mitigation in the general population

Authors: Mangesh A. Thorat, Jack Cuzick

Published in: European Journal of Epidemiology | Issue 1/2015

Abstract

A careful assessment of benefits and harms is required to assess suitability of aspirin as a prophylactic public health measure. However, comprehensive population-level data on harms are lacking. We collected and synthesized age and sex-specific data on harms relevant to aspirin use in average-risk individuals aged 50 years or older. We conducted systematic literature searches to identify baseline rates of gastrointestinal (GI) bleeding, peptic ulcer, major extra-cranial bleeding, and case-fatality rates due to GI bleeding or peptic ulcer in general population. The magnitude of aspirin-associated increase, the prevalence and attributable risk of Helicobacter pylori infection on these events in aspirin users was also assessed. Baseline rates of major extracranial bleeding events and GI complications increase with age; an almost threefold to fourfold increase is observed from age 50–54 to 70–74 years. Low or standard-dose aspirin use increases GI bleeding events by 60 % leading to an annual excess of 0.45 and 0.79 GI bleeding events per 1,000 women and men aged 50–54 years respectively. 5–10 % of major GI complications are fatal; a clear age dependence—higher fatality in older individuals, is seen. Eradication of H. pylori infection before aspirin use could reduce the incidence of upper GI complications by 25–30 %. GI complications are increased by about 60 % due to aspirin use but are fatal only in a very small proportion of individuals younger than 70 years of age. Major bleeding events that are comparable in severity to cancer or CVD, are infrequent. Screening and eradication of H. pylori infection could substantially lower aspirin-related GI harms.

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Title: Prophylactic use of aspirin: systematic review of harms and approaches to mitigation in the general population
Authors: Mangesh A. Thorat
Jack Cuzick
Publication date: 01-01-2015
Publisher: Springer Netherlands
Published in: European Journal of Epidemiology / Issue 1/2015
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI: https://doi.org/10.1007/s10654-014-9971-7

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Other articles of this Issue 1/2015

Should non-cardiovascular mortality be considered in the SCORE model? Findings from the Prevention of Renal and Vascular End-stage Disease (PREVEND) cohort

Overweight, obesity and risk of all-cause and cardiovascular mortality in patients with type 2 diabetes mellitus: a dose–response meta-analysis of prospective cohort studies

IEA-EEF makes agreement with Springer Publishers

The European Journal of Epidemiology and the European Epidemiology Federation

Determinants of the prevalence of gout in the general population: a systematic review and meta-regression

Mortality benefits of population-wide adherence to national physical activity guidelines: a prospective cohort study