Safety of Ceasing Aspirin Used Without a Clinical Indication After Age 70 Years: A Subgroup Analysis of the ASPREE Randomized Trial
Mark R. Nelson, Galina Polekhina, Robyn L. Woods, Christopher M. Reid, Andrew M. Tonkin, Rory Wolfe, Anne M. Murray, Brenda Kirpach, Michael E. Ernst, Jessica E. Lockery, Raj C. Shah, Nigel Stocks, Suzanne G. Orchard, Zhen Zhou
Abstract
Background: The ASPREE (ASPirin in Reducing Events inthe Elderly) trial was a randomized, double-blind, placebocontrolledprimary prevention trial of aspirin in 19114 communitydwellingpersons aged 70 years and older (≥65 years in U.S.racial minorities). The results of the trial demonstrated that aspirinhad no benefit for disability-free survival, prevention of cardiovasculardisease events, or prevention of incident cancer,and increased risk for major bleeding and all-cause mortality(1–3). These findings were interpreted by some as being relevantonly to aspirin initiation and not aspirin discontinuation (4).The availability of evidence to inform the risks (for example, forgonecardiovascular protection) and benefits (for example,decreased risk for major hemorrhage) from aspirin cessationamong older adults is timely, given updated guideline recommendationsregarding aspirin use and clinical uncertainty (5). Objective: To investigate the effect of aspirin cessation versuscontinuation on disability-free survival and other clinical outcomesin a post hoc analysis of ASPREE participants who wereregularly taking aspirin before trial enrollment.