Guideline‐Adherent Aspirin Use in Individuals with Age‐Related Macular Degeneration

Nearly 50% of adults aged 65 and older in the United States take aspirin at least every other day.1 Aspirin use has numerous well-described risks, including hemorrhagic strokes and gastrointestinal bleeding.2-4 Recent studies have highlighted a putative association between aspirin use and exudative age-related macular degeneration (AMD), including intraocular and subretinal hemorrhages.5-8 These findings underscore the importance of assessing the risks of aspirin use in elderly adults, especially those with AMD, but the extent to which individuals with AMD take aspirin in accordance with guidelines is not well described. To better characterize the nature of aspirin use in the population with AMD, this study investigated the prevalence of individuals with AMD in a hospital-based eye clinic taking aspirin in accordance with current guidelines from the U.S. Preventative Services Task Force (USPSTF).9 After obtaining institutional review board (IRB) approval from the Providence Veterans Affairs Medical Center (PVAMC), electronic medical records of individuals aged 50 and older with AMD who visited the PVAMC eye clinic in 2011 and whose primary care physician (PCP) was a PVAMC provider were retrospectively reviewed. Records were limited to those written by a PCP during visits within the past 5 years, dating back to June 2007. Data were abstracted on demographic characteristics, anticoagulant use, retinal and systemic comorbidities, hemorrhagic complications, the number of individuals taking aspirin, the dose of aspirin, and whether a PVAMC physician prescribed aspirin. For individuals taking aspirin who were within the USPSTF recommended age range for aspirin (45–79 for men, 55–79 for women), records were examined for the following evidence of aspirin use in accordance with USPSTF guidelines:9 documentation of a rationale for taking aspirin and a discussion with a physician (their PCP in this study) within the past 5 years about aspirin-related risks. A generic notation in the record indicating that a review of all of an individual's medications had occurred was considered insufficient evidence of a discussion of aspirin-related risks, given that a typical visit rarely allows enough time for such conversations. There were 401 individuals who met inclusion criteria; their mean age was 79, 98% (n = 392) were male, and 94% (n = 376) were white. Summary data regarding their comorbidities and use of antithrombotics are reported in Table 1. Of the 65% (n = 262) who took aspirin, the dosages ranged from 50 to 325 mg/d, and 44% (n = 116) had an aspirin prescription from a PVAMC provider; 56% (146) and 2% (n = 5) had documented cardiovascular (e.g., prevention of stroke) and noncardiovascular reasons (e.g., chronic pain management), respectively, for taking aspirin. One percent (n = 3) of patients were taking aspirin in accordance with USPSTF guidelines. Guideline-recommended discussions about risks of aspirin or documented rationales for taking aspirin are rare, which is troubling given the potential for serious aspirin-related complications in individuals with AMD.2, 3 Potential limitations of this study include its retrospective design and its focus on a largely white male cohort of U.S. veterans, which may affect its generalizability. In summary, further research is needed on ways to improve physician–patient communication on the risks of aspirin in elderly adults, especially those with comorbidities that may predispose them to aspirin-related complications. Submitted for presentation at the 2013 Annual Scientific Meeting of the American Geriatrics Society, Grapevine, Texas, May 3–5, 2013. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the U.S. government. Conflict of Interest: None. Author Contributions: Ramaswamy: developing the study, preparing submission to the IRB of the PVAMC, collecting and analyzing data, and preparing the manuscript. Krzystolik and Greenberg: developing the study, preparing submission to the IRB of the PVAMC, analyzing data, and preparing the manuscript. Sponsor's Role: None.