Key result
Aspirin cessation compared with continuation in older prior regular users resulted in an inconclusive increased risk (HR 1.28) for the primary composite of mortality, dementia, or physical disability.
Why the study?
Evidence to inform the risks and benefits of aspirin cessation among older adults regularly taking aspirin without a clinical indication is needed given updated guideline recommendations and clinical uncertainty.
RCT (n=1,714)
Double-blind
Randomized
Yes
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.
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A 2022 study conducted an RCT in Primary prevention without clinical indication for aspirin (n=1,714). Aspirin cessation (placebo) vs. Aspirin continuation was evaluated on Composite of all-cause mortality, incident dementia, or persistent physical disability (HR 1.28, 95% CI 0.98 to 1.68). Aspirin cessation compared with continuation in older prior regular users resulted in an inconclusive increased risk (HR 1.28) for the primary composite of mortality, dementia, or physical disability.
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