Researchers looked into how low-dose aspirin affected older person’s risk of stroke. They discovered that low-dose aspirin increased the risk of cerebral bleeding by 38% but did not significantly reduce the risk of stroke.

Before administering aspirin to prevent stroke, doctors should examine patients for cardiovascular and head injury risks.

An ischemic stroke, also known as a blocked blood vessel in the brain, or a hemorrhagic stroke, often known as an unexpected burst of bleeding in the brain, both constitute strokes.

Every year, more than 795,000 people in the US experience a stroke. Stroke is a factor in about 1 in 6 deaths from cardiovascular diseases.

The incidence of stroke must be decreased through preventive measures. Aspirin, a common pain reliever, is currently used extensively to prevent the condition.

The risk of intracranial and intracerebral haemorrhages, or bleeding in the skull and brain, may increase even if meta-analyses suggest that low-dose aspirin may lower the risk of stroke.

Due to the fragility of their small blood vessels and their higher risk of injury from incidents like falling, older people are particularly vulnerable to haemorrhaging. These elements could change how aspirin’s risks and benefits balance out.

Stroke prevention measures may be influenced by knowing how low-dose aspirin impacts older person’s risk for stroke and hemorrhage.

Recent studies looked into how low-dose aspirin affected older persons’ risk for stroke and haemorrhage. Low-dose aspirin increased the incidence of cerebral haemorrhage by 38% while having no effect on stroke risk.

Low-dose aspirin’s effects on stroke risk

The average age of the 19,114 persons whose data were analysed for the study was 74. None of the participants, who made up about 56% of the total, had a history of cardiovascular diseases like:

• stroke
• AFib, or atrial fibrillation
• chest pain

The individuals were divided into two groups at random and given a daily dose of 100 mg of aspirin or a placebo. They were monitored for 4.7 years on average.

Low-dose aspirin use was discovered to be associated with marginal, clinically inconsequential decreases in the incidence of ischemic stroke.

Stroke occurred in 1.5% of those who received aspirin (146 people), whereas it happened in 1.7% of the placebo group (166 people). Additionally, there was no statistically significant decrease in hemorrhagic strokes after using aspirin.

A hemorrhagic stroke occurred in 0.5% of aspirin-assigned participants (49 people), although 0.4% of placebo-assigned participants (37 people) also experienced one. The researchers also discovered that aspirin users had a markedly increased risk of cerebral hemorrhage compared to those taking a placebo.

Intracranial hemorrhage occurred in 1.1% of aspirin-taking participants (108 people), compared to 0.8% of placebo-taking participants (79 people). Dr. Arun Manmadhan, an assistant professor of medicine at Columbia University’s Vagelos College of Physicians and Surgeons who was not engaged in the study, provided the following information to us:

This study adds to the growing body of evidence showing that routine aspirin usage to prevent first-time cardiovascular events in the general adult population has minimal benefits and may even be harmful due to increased bleeding, especially in older persons. This study supports previous recommendations from the U.S. Preventive Services Task Force that persons over 60 should not regularly take aspirin to prevent cardiovascular disease.

Although aspirin is a blood thinner, low doses may cause more brain bleeding.

Experts discussed how aspirin may lower the risk of stroke with Dr. Hardik P. Amin, associate professor of neurology at Yale School of Medicine who was not involved in the study.

He claimed that individuals at risk for cardiovascular diseases may develop little clusters of blood platelets, a type of blood cell that facilitates clotting, inside their blood arteries.

Aspirin stops platelets from aggregating inside blood arteries, which results in its blood-thinning action and lowers the chance of a heart attack or stroke, according to Dr. Amin.

Experts also enquired about how aspirin might raise the risk of cerebral hemorrhage Dr Walavan Sivakumar, a board-certified neurosurgeon and the director of neurosurgery at Pacific Neuroscience Institute-South Bay in Torrance, California was not involved in the study.

Aspirin may enhance the risk of brain haemorrhage in the same manner that it lowers the likelihood of blood clots developing and travelling to the brain, according to Dr. Sivakumar.

“One of the ways that the body stops bleeding is by forming blood clots. As a result, aspirin also makes it harder for the body to stop bleeding once it starts,” the doctor explained.

Need for larger investigations on the dangers of aspirin at low doses

Dr. Maria Parekh, an expert on stroke and an assistant professor of neurology at McGovern Medical School at UTHealth Houston who was not involved in the study, was consulted by experts regarding its limitations.

She pointed out that because there weren’t many episodes of cerebral hemorrhage and stroke in the study overall, the conclusions could have been tainted by random and intentional mistakes.

Aspirin is also known to help those who have experienced an ischemic stroke, in which the blood supply to the brain is halted or diminished, as it prevents blood clots from developing that could cause another stroke, Dr. Parekh continued. She stated that this is referred to as “secondary prevention.”

However, this research focused on the use of aspirin as “primary stroke prevention,” specifically in healthy older persons “free of overt cardiovascular disease,” to prevent first-time ischemic stroke. As a result, it excludes those who would most likely benefit from taking low dose aspirin, Dr. Maria Parekh pointed out.

Dr. Ziad Hage, a cerebrovascular and endovascular neurosurgeon at Novant Health in Charlotte, North Carolina, who is board-certified and fellowship-trained, was also questioned by experts about the study.

He said that groups at high risk of stroke or secondary stroke prevention may not be affected by the findings. He cautioned that the results might not apply to more varied demographics because the study’s participants were mostly older, white, and had easy access to blood pressure and lipid-lowering drugs.

Do you need to quit using low-dose aspirin?

These results indicate that advocating aspirin use can hurt patients who are healthy and have no cardiovascular risk factors, according to Dr. Sivakumar.

“At that point, patients may choose to make more conservative lifestyle changes, such as eating a healthy diet and exercising frequently.”

Dr. Hage concurred that individuals who had a higher risk of developing cardiovascular diseases like stroke should take aspirin. He said that unless required, aspirin should also be avoided by individuals who have a higher risk of falling.

In conclusion, it’s critical that the public comprehend that aspirin can be helpful in some circumstances, thus speaking with an expert on the subject is of the utmost importance. Stroke symptoms include sudden onset, facial, arm, or leg weakness, speech slurring or difficulty speaking, sudden loss of vision in one eye, and sudden loss of balance, among other symptoms. Dr. Ziad Hage, a cerebrovascular and endovascular neurosurgeon, advised patients to get medical attention if they experience any of these symptoms.

REFERENCES:

• https://www.medicalnewstoday.com/articles/low-dose-aspirin-raises-brain-bleeding-risk
• https://www.healthline.com/health-news/daily-low-dose-aspirin-can-increase-risk-of-brain-bleeding-what-to-know
• https://www.everydayhealth.com/heart-health/low-dose-aspirin-linked-bleeding-skull/

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