Short- and long-term impact of aspirin cessation in older adults: a target trial emulation.
BMC Med
; 22(1): 306, 2024 Jul 29.
Article
em En
| MEDLINE
| ID: mdl-39075484
ABSTRACT
BACKGROUND:
The net benefit of aspirin cessation in older adults remains uncertain. This study aimed to use observational data to emulate a randomized trial of aspirin cessation versus continuation in older adults without cardiovascular disease (CVD).METHODS:
Post hoc analysis using a target trial emulation framework applied to the immediate post-trial period (2017-2021) of a study of low-dose aspirin initiation in adults aged ≥ 70 years (ASPREE; NCT01038583). Participants from Australia and the USA were included if they were free of CVD at the start of the post-trial intervention period (time zero, T0) and had been taking open-label or randomized aspirin immediately before T0. The two groups in the target trial were as follows aspirin cessation (participants who were taking randomized aspirin immediately before T0; assumed to have stopped at T0 as instructed) versus aspirin continuation (participants on open-label aspirin at T0 regardless of their randomized treatment; assumed to have continued at T0). The outcomes after T0 were incident CVD, major adverse cardiovascular events (MACE), all-cause mortality, and major bleeding during 3, 6, and 12 months (short-term) and 48 months (long-term) follow-up. Hazard ratios (HRs) comparing aspirin cessation to continuation were estimated from propensity-score (PS) adjusted Cox proportional-hazards regression models.RESULTS:
We included 6103 CVD-free participants (cessation 5427, continuation 676). Over both short- and long-term follow-up, aspirin cessation versus continuation was not associated with elevated risk of CVD, MACE, and all-cause mortality (HRs, at 3 and 48 months respectively, were 1.23 and 0.73 for CVD, 1.11 and 0.84 for MACE, and 0.23 and 0.79 for all-cause mortality, p > 0.05), but cessation had a reduced risk of incident major bleeding events (HRs at 3 and 48 months, 0.16 and 0.63, p < 0.05). Similar findings were seen for all outcomes at 6 and 12 months, except for a lowered risk of all-cause mortality in the cessation group at 12 months.CONCLUSIONS:
Our findings suggest that deprescribing prophylactic aspirin might be safe in healthy older adults with no known CVD.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Doenças Cardiovasculares
/
Aspirina
Limite:
Aged
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Aged80
/
Female
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Humans
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Male
País/Região como assunto:
America do norte
/
Oceania
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article