Journal of the Hong Kong Geriatrics Society

Volume 11 Number 1, January 2002

Tolerability of aspirin and predictors for withdrawal in elderly patients

CC Mok, YK Kwan

Aspirin has been proven to reduce risk of thrombotic cardiovascular events such as ischemic stroke and myocardial infarction. However, side effects are not uncommon with gastrointestinal side effects and haemorrhagic complications being the commonest causes of its withdawal from treatment. A retrospective review was performed to study the tolerability of aspirin in elderly patients and predictors for drug withdrawal. Between 1995 and 1999, 285 consecutive patients aged over 60 who were started on aspirin and followed up in the Geriatrics outpatient clinic of Tuen Mun Hospital were recruited for study. Case notes were reviewed and the end-point was reached when aspirin had to be discontinued because of toxicities. Four patients in whom aspirin was stopped because of frailty or non-compliance were excluded. Of the remaining 281 patients, there were 165 females (58.7%) and 116 males (41.3%). The mean age at entry was 76.2 ± 7.0 (range 60-92) years. The mean duration of aspirin therapy was 17.0 ± 14 (range 1-50) months and the mean dosage was 111 ± 39 (range 80-300) mg. The cumulative probabilities of aspirin withdrawal at 12, 24 and 36 months were 13.1%, 17.5% and 23.8%, respectively. At the time of analysis, aspirin was stopped in 42 (15.0%) patients and the main reasons were endoscopically documented peptic ulceration (21/42, 50%) with or without gastrointestinal bleeding, gastritis (4/42, 9.5%), dyspepsia with normal endoscopy (3/42, 7%) and dyspepsia but patients refused an endoscopy (10/42, 23. 8%). Univariate analysis revealed that an albumen level of <= 35g/L (p=0.002), hemoglobin <= 11.0 g/dL (p=0. 004), previous history of peptic ulcer or dyspepsia (p=0.007) and concomitant non-steroid anti-inflammatory drug (NSAID) use (p=0.003) were predictive factors for aspirin withdrawal. Multivariate analysis using the Cox proportional hazard model revealed history of peptic ulcer or dyspepsia (HR 5.4 [2.1-14.4], p=0.007) was independent risk factors for aspirin withdrawal. Extra caution should be given when aspirin is going to be commenced in this subset of elderly patients. (J HK Geriatr Soc 2002; 11:11-15)

Keywords : acetylsalicylic acid, peptic ulcer disease, risk factors, geriatric

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