Aspirin Warning: Anemia May Increase With Use

[Manouche]

 »Older people who take daily low-dose aspirin have at 20% higher risk of developing anemia even without having already had a major bleeding event, according to results from a new randomized controlled trial.

In the study, which was published June 20 in the Annals of Internal Medicine, investigators analyzed data from the Aspirin in Reducing Events in the Elderly (ASPREE) and examined hemoglobin concentrations among 19,114 healthy, community-dwelling older patients.

"We knew from large clinical trials, including our ASPREE trial, that daily low-dose aspirin increased the risk of clinically significant bleeding," Zoe McQuilten, MBBS, PhD, a hematologist at Monash University in Australia and lead author on the study, said. "From our study, we found that low-dose aspirin also increased the risk of anemia during the trial, and this was most likely due to bleeding that was not clinically apparent."

Anemia is common among elderly patients. It can cause fatigue, fast or irregular heartbeat, headache, chest pain, and pounding or whooshing sounds in the ear, according to the Cleveland Clinic. It can also worsen conditions such as congestive heart failure, cognitive impairment, and depression in people aged 65 and older.

The US Preventive Services Task Force changed its recommendation on aspirin for the primary prevention of cardiovascular disease in 2022, recommending against initiating low-dose aspirin for adults aged 60 years or older. For adults aged 40 to 59 who have a 10% or greater 10-year risk for cardiovascular disease, the agency recommends that patients and clinicians make the decision to initiate low-dose aspirin use on a case-by-case basis, as the net benefit is small.

McQuilten said she spent the last 5 years designing substages of anemia and conditions such as blood cancer. In many cases of anemia, doctors are unable to determine the underlying cause, she said. One study published in the Journal of American Geriatrics Society in 2021 found that in about one third of anemia cases, the etiology was not clear.

About 50% of people older than 60 who were involved in the latest study took aspirin for prevention from 2011 to 2018. That number likely dropped after changes were made to the guidelines in 2022, according to McQuilten, but long-term use may have continued among older patients »

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[Mazcd Partner MPNVoice]

It is advisable to balance the risk versus benefit, if anyone has any concerns about aspirin you are advised to discuss this with your haematologist and GP.

[hunter5582]

Interesting research that is consistent with the changing recommendations about the use of aspirin as a routine preventative agent. For most people in a certain age group (age >60) there is an increased risk of hemorrhage that outweighs the preventative benefits. Issues like a hemorrhagic stroke are a known risk.

People with MPNs have a different risk profile than people without a MPN. For many, there is an increased risk of thrombosis that must be managed. Low dose aspirin can help manage this risk, but at the same time cause its own adverse effects. It is a balancing act, weighing risks vs benefits. This decision requires an individualized approach for each person with a MPN, which is based on that individual's MPN profile. There are a number of factors that need to be considered. One size does not fit all.

I did experience a significant increase in hemorrhage as I reached age 60 and was taking aspirin. It seemed worse when my platelet levels were near 800. The unexplained bruising and excessive bleeding were problematic. My MPN specialist recommend that I discontinue the aspirin, not wanting to risk a brain bleed. That was when we found that I had a brain tumor that had bled internally. I went off aspirin for several years, but started to experience erythromelalgia in the toes/feet. going back on aspirin solved the problem immediately. For me, the benefit was once again worth the risk.

What I would take from this article is not that people with MPNs should avoid aspirin or other antiplatelet medications. It is that we should not take the use of these medications for granted. There are intrinsic risks that are associated with their use. The risk of occult bleeding is something to be aware of. It seems very reasonable to monitor iron levels as one of the standard monitoring protocols for people with MPNs, particularly when on an aspirin regimen. Iron deficiency can cause significant problems even when anemia is not evident.

As Mazcd indicates, the use of aspirin is a decision each person has to make with their hematologist. Ideally, this would be a MPN Specialist who has the ability to individualize MPN care rather than simply follow a protocol that applies to most but not all people with a MPN.

Thanks for posting this interesting article.

[Dan73 in reply to hunter5582]

I take low dose enteric coated aspirin. Now I wonder if I should stop taking turmeric/ curcumin. Some sources say that turmeric enhances the anti-clotting effects of aspirin. I have PV.

[hunter5582 in reply to Dan73]

Most anti-inflammatory agents are to some degree blood thinning and may potentiate aspirin. I avoid using fish oil for this reason. I have been using curcumin for some time now along with aspirin. there is no potentiation that I can discern in my case.

I did at one point find that I was experiencing excessive hemorrhage while on daily aspirin as I aged and when platelets were at their higher levels. There was a concomitant reduction in von Willebrand factors when my PLTs were elevated as well. Likely all part of the overall picture. Now that platelets are well controlled, I no longer experience the excessive hemorrhage while on aspirin (along with curcumin, L-glutathione, and SPM Active). The level of inflammation I experience would be disabling if not for the successful treatment with the anti-inflammatory agents I use. The risk is well worth the benefits.

Suggest that you consult with an Integrative or Functional Medicine doctor regarding supplement-drug interactions. these specialists are much more familiar with these interactions than most docs.

All the best.

[Dan73 in reply to hunter5582]

Thank you. I haven’t had any significant bleeding issues so far and my platelets are well controlled. I take 500 mg of HU per day.

[Amethist]

great to highlight these issues. I personally found when taking daily aspirin- as per advice of my haem- I got a lot of bruising, and it did concern me greatly about what was happening inside me, where I can’t see. My own research revealed how many people die every year just from taking aspirin. Plus in USA especially, taking prescription drugs as prescribed by your doctor is the 3rd leading cause of death. Makes you question things, especially the knowledge of Drs. My haem was really out of date with his info on ET so I considered him to be too dangerous to see.

I just take a ½ aspirin only if my toes tingle, so usually every third or fourth day or so.

[ERei]

This is very interesting as I have recently developed anemia and neither my MPN doc or my GI doc know why. I've been scoped (upper & lower) twice now looking for a GI bleed but nothing has been identified. I'm now on iron supplements and they are just watching.

[saltmarsh]

Thanks for posting. I am currently dealing with mild anemia and no cause. My hematologist thinks a daily aspirin is overkill for most and 2-3 a week will do the job. Much appreciated

[Exeter21]

Interesting article as I have been suffering with palpitations on aspirin. I experimented by leaving it off a few days & symptoms went. I will discuss with my MPN thanks 👍

[jewelmaker]

I am 74 years old, have ET (platelets currently just under 500) take 1000 mg of Hydroxyurea, fish oil, as well as 325mg of aspirin, all daily. I was put on aspirin in October 2022 when I was diagnosed with ET. Should I be concerned about this much aspirin daily?

[Mirror368 in reply to jewelmaker]

325 mg aspirin is the same as taking 4 low dose aspirins daily. I would check with your doctor,