Long term ues of Low-dose aspirin use linked to anaemia among elderly

Australia: A recent study in Annals of Internal Medicine found increased incident anaemia and a decline in ferritin with the use of low-dose aspirin in otherwise healthy older adults, independent of major bleeding. 

"Low-dose aspirin was associated with a 20% increased incidence of anaemia and decline in ferritin, or blood iron levels," the researchers reported in the analysis of the ASPREE (ASPirin in Reducing Events in the Elderly) trial. "These findings suggest that periodic haemoglobin monitoring should be considered in older patients taking aspirin." 

Approximately half of older persons in the United States have reported preventative aspirin use. One of the complications of aspirin use is an increased risk for major bleeding, particularly gastrointestinal bleeding. Although the risk for overt bleeding due to aspirin has been well characterized, very few studies have measured the effect of aspirin on anaemia, particularly in older populations.

Researchers from Monash University, Melbourne, conducted a post-hoc analysis of the ASPREE randomized controlled trial. The trial included 19,114 persons aged 70 years or older randomly assigned to take 100 mg of aspirin daily or placebo. Haemoglobin was measured annually, and ferritin was measured at baseline and 3 years after randomization. The data showed that the risk for developing anaemia was 23.5 percent among those assigned to receive low-dose aspirin.

These results were accompanied by a small but greater decrease in mean haemoglobin and a greater decline in ferritin concentrations among those receiving aspirin. Differences in clinically significant bleeding events did not account for the overall difference in incident anaemia or the decline in ferritin observed in ASPREE. Still, they were most likely due to occult blood loss, given the observed steeper decline in ferritin in participants allocated to aspirin.

Reference:

Zoe K. McQuilten, Le Thi Phuong Thao, Sant-Rayn Pasricha,  Andrew S. Artz, Michael Bailey, Andrew T. Chan, Harvey Jay Cohen, Jessica E. Lockery,  Anne M. Murray, Mark R. Nelson, Hans G. Schneider, Rory Wolfe, Robyn L. Woods, Erica M. Wood, John J. McNeil, https://doi.org/10.7326/M23-0675.