Key result
Aspirin 100 mg/d was associated with an increased incidence of total bleeding events compared to 50 mg/d (28.34 vs 17.25 events/100 patient-years; HR 1.671; 95% CI 1.024-2.712; P=0.040).
Why the study?
Aspirin reduces atherothrombosis but increases bleeding, and elderly patients face increased risks of both cardiovascular disease and hemorrhage.
Does aspirin 50 mg/d compared to 100 mg/d reduce bleeding events without increasing MACE in elderly Chinese patients requiring long-term aspirin for CVD prevention?
Cohort (n=426)
No
Does aspirin 50 mg/d compared to 100 mg/d reduce bleeding events without increasing MACE in elderly Chinese patients requiring long-term aspirin for CVD prevention?
Hazard Ratio: 1.671 (95% CI 1.024–2.712)
Absolute Event Rate: 28.34% vs 17.25%
p-value: p=0.040
In Chinese elderly patients requiring long-term aspirin, a 50 mg/d dose may provide similar cardiovascular protection with a significantly lower risk of bleeding compared to the standard 100 mg/d dose.
May favor 50 mg/d over 100 mg/d to limit bleeding in elderly Chinese; leaves optimal dosing open for RCTs.
Purpose: Although aspirin can effectively reduce the occurrence of atherothrombosis, it is significantly associated with increased bleeding, with elderly individuals being at increased risk of cardiovascular diseases (CVD) and hemorrhage. This study aims to evaluate the efficacy and safety of aspirin 50 mg/d and 100 mg/d for the prevention and management of CVD in Chinese elderly. Patients and Methods: The Low-dose Aspirin for Primary and Secondary Prevention of Cardiovascular Disease in the Elderly Study (LAPIS) is a multicenter, prospective, observational cohort study, this study was a single-center interim analysis of LAPIS. Patients aged ≥60 and required long-term aspirin for primary and secondary prevention of CVD were eligible. From Apr 1, 2019 to Feb 28, 2022, 165 patients who received 50 mg/d aspirin and 261 patients who received 100 mg/d aspirin were included in the study. The incidence of major cardiovascular events (MACEs), bleeding events, and gastrointestinal adverse events were compared between two groups. Results: After adjusting for patient characteristics using propensity score matching, aspirin 100 mg/d was associated with increased incidence rates of total bleeding events (28.34 vs.17.25 events/100 patient-years, HR 1.671, 95% CI 1.024-2.712, P = 0.040) and minor bleeding events (27.63 vs.15.92 events/100 patient-years, HR 1.738, 95% CI 1.056-2.861, P = 0.031), whereas the incidence of MACE (6.35 vs 6.65 events/100 patient-years, HR 0.921, 95% CI 0.399-2.127, P = 0.848) and gastrointestinal adverse events (12.73 vs.10.42 events/100 patient-years, HR 1.206, 95% CI 0.623-2.337, P = 0.578) were similar between the two groups. Multivariate Cox analysis identified that aspirin dose (100 mg/d vs. 50 mg/d, HR 1.918, 95% CI 1.137-3.235, P = 0.015), concomitant use of other antiplatelets (HR 1.748, 95% CI 1.009-3.028, P = 0.046) and anticoagulants (HR 2.501, 95% CI 1.287-4.862, P = 0.007) were independently associated with bleeding events. Conclusion: 50 mg/d aspirin may be preferred to balance the safety and effectiveness in Chinese individuals over 60 years of age who need long-term aspirin for the prevention and management of CVD. Trial Registration: ChiCTR1900021980 (chictr.org.cn). Registered on 19 March 2019.
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Wang et al. (2022) conducted a cohort in Cardiovascular disease (n=426). Aspirin vs. Aspirin 50 mg/d was evaluated on Total bleeding events (HR 1.671, 95% CI 1.024-2.712, p=0.040). Aspirin 100 mg/d was associated with an increased incidence of total bleeding events compared to 50 mg/d (28.34 vs 17.25 events/100 patient-years; HR 1.671; 95% CI 1.024-2.712; P=0.040).
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