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Call to co-prescribe PPIs with daily aspirin for older patients

Call to co-prescribe PPIs with daily aspirin for older patients

The researchers, from the Centre for Prevention of Stroke and Dementia, said that "given that half of the major bleeds in patients aged 75 years or older were upper gastrointestinal, the estimated NNT for routine PPI use to prevent such bleeds is low, and co-prescription should be encouraged".

As half of the major bleeds recorded in the over-75s were upper gastrointestinal (GI), the study also looked at the effect of PPIs, which can reduce upper GI bleeding by up to 90% in patients on long-term antiplatelet therapy.

Around 40% of adults aged 75 or over in the United Kingdom take a daily aspirin and lifelong treatment is recommended for patients who have previously had a heart attack or stroke.

Worryingly, this advice was based on trials involving younger patients for just two to four years.

Their study followed 3,166 patients who had previously had a stroke or heart attack and were prescribed aspirin or similar blood-thinning drugs. For that reason, people under 75 are not to be anxious by this study. During this time, a total of 314 patients were admitted to hospital for internal bleeding.

They found that, for patients aged under 65, the annual rate of disabling or fatal bleeds was less than 0.5% (around one person in every 200 people taking the medication).

The risk of disabling or fatal bleeding was ten times higher among those aged 75-plus than in younger patients.

The annual rate of life-threatening or fatal bleeds was less than 0.5 per cent, for patients under 65, 1.5 per cent for those aged 75 to 84 and nearly 2.5 per cent for patients aged 85 or over, "The Guardian" reported. But for patients aged 75-84, the rate rose to around 1.5%, and to almost 2.5% for patients aged 85 or over.

Professor Sir Nilesh Samani, medical director at the British Heart Foundation, which co-funded the research, said: "For some patients aspirin is an important part of our armoury to prevent heart attacks and strokes".

The proportion of survivors experiencing a new or worse disability rose from three per cent for those under 75 to 25 per cent among older patients. "Therefore, any uncertainty about the small risks of PPI use are very likely to be outweighed by the benefits", said Professor Rothwell.

Lead author Professor Peter Rothwell said: 'We have known for some time that aspirin increases the risk of bleeding for elderly patients.

'The risk of serious bleeding is much higher in the over-75s.

"Previous studies have shown there is a clear benefit of short term antiplatelet treatment following a heart attack or stroke", he said.

LONG-term aspirin use has been shown to cut the risk of developing lung, breast and other cancers. But "the new data should provide reassurance that the benefits of PPI use at older age outweigh the risks". He also agreed with the study authors that PPIs should be used more often in older people taking antiplatelet therapy. As it now stands, PPIs are being prescribed only in the minority of cases.

Until now, most research involved people under 75, showing that the risk of serious bleeds was low in this group.

"It will continue to be necessary to make decisions of a case by case basis, considering the patient's unique circumstances and medical history, as well as the medications they are already taking and how they will interact with each other".


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