Anywhere from 40% to 60% of older people take daily to prevent a
or stroke. Studies have shown that low doses of the blood-thinner can
significantly lower the risk of heart problems, especially among people
who have already had a or stroke.
But in a study published in the Lancet, researchers say that the risks of
haven’t been properly studied in older people. Most of the studies
showing the over-the-counter drug’s benefits have included younger
people under 65 years. However, most people who are currently taking
daily for their heart are older.
In
the study, Peter Rothwell, professor of neurology at the University of
Oxford, and his colleagues analyzed data from the Oxford Vascular Study,
which followed more than 3,000 people who had had a or stroke and were given
or other anti-clotting drugs by their doctors. After 10 years, Rothwell
found that ulcers and bleeding events—a common side effect of —were more common among people over 75 than those under 65.
Once
the bleeding events occurred, most commonly in the stomach or digestive
tract, the bleeding was more intense and severe in older people than in
younger people.
“The
overall increased risk for older people surprised us,” says Rothwell.
“And the proportion who did have major consequences from the bleeding
also surprised us. We were surprised by the extent to which the bleeds
were causing disability and even death.”
About
1.5% of the people in the study under age 65 were admitted to the
hospital for bleeding problems, compared to 3.5% for those aged 75-84
and 5% for people over age 85. The risk of having disability or even
dying after a bleeding event because of complications was 10 times
higher for those over age 75 than for younger people.
In fact, says Rothwell, for older people, the risks associated with bleeding were actually higher than the risk of having a or stroke, which the was supposed to prevent.
The data point to an increasing disconnect that doctors are experiencing when they see older patients. While
is generally regarded as safe, and the risk of bleeding is often
considered minor and easily addressed, that's not the case among older
people. “In our clinical experience, for people in their 80s and 90s,
bleeds can actually be devastating,” says Rothwell. “People sometimes
don’t regain their mobility, they can develop delirium, they go to the
hospital and never regain the same level of cognitive function. There’s
been an assumption in the past that all bleeds from are like pests and dismissed as not a major problem, but perhaps that’s not so true in the elderly.”
Fortunately, there is a way to offset the risk of bleeding from :
by prescribing a proton pump inhibitor, a class of drugs that reduces
the amount of acid, which can contribute to bleeding, produced by the
stomach. Studies show that they can reduce bleeding events by up to 90%
in the tract. But doctors have been reluctant to add another drug to an
elderly person’s typically long list of medications, and the practice of
viewing -related bleeds as minor also means that the risks of bleeding aren’t being addressed properly.
The study’s findings add more information to the growing discussion about the safety of daily . Recent studies found that older people taking low doses of every day can lower their risk of not only but certain cancers, due to the drug’s -reducing
effect. But Rothwell’s data should encourage patients to ask their
doctors about whether they would benefit from daily —or
suffer more from side effects. The risk-benefit equation may be
different for people who have already had a heart event, compared to those who may be at risk of having a heart attack
and want to prevent that from happening. The American Heart Association
and the U.S. Preventive Services Task Force currently recommend daily
for people who have not yet had heart problems, but only if they are at
particularly high risk of having an event. The Food and Drug
Administration, on the other hand, does not recommend that people who have not yet had a heart event take on a daily basis to prevent a first-time event.
If you are already taking daily after a ,
or in an effort to prevent your first one, Rothwell does not recommend
that you stop immediately, since that can also cause a rebound effect
that could be bad for your health. But he says it might be worth
discussing with your doctor whether adding a proton pump inhibitor would
make sense to protect you from the potentially dangerous side effects
of bleeding.
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