Journal article
Short- and long-term impact of aspirin cessation in older adults: a target trial emulation
BMC medicine, Vol.22(1), 306
07/29/2024
DOI: 10.1186/s12916-024-03507-8
PMCID: PMC11287830
PMID: 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.
Details
- Title: Subtitle
- Short- and long-term impact of aspirin cessation in older adults: a target trial emulation
- Creators
- Zhen Zhou - Monash UniversityKatherine L. Webb - Monash UniversityMark R. Nelson - University of TasmaniaRobyn L. Woods - Monash UniversityMichael E. Ernst - University of IowaAnne M. Murray - Hennepin Healthcare Research InstituteAndrew T. Chan - Massachusetts General HospitalAndrew Tonkin - Monash UniversityChristopher M. Reid - Monash UniversitySuzanne G. Orchard - Monash UniversityBrenda Kirpach - Berman Center for Outcomes and Clinical ResearchRaj C. Shah - Rush University Medical CenterNigel Stocks - University of AdelaideJonathan C. Broder - Monash UniversityRory Wolfe - Monash University
- Resource Type
- Journal article
- Publication Details
- BMC medicine, Vol.22(1), 306
- Publisher
- BioMed Central
- DOI
- 10.1186/s12916-024-03507-8
- PMID
- 39075484
- PMCID
- PMC11287830
- ISSN
- 1741-7015
- eISSN
- 1741-7015
- Language
- English
- Date published
- 07/29/2024
- Academic Unit
- Family and Community Medicine; Pharmacy Practice and Science
- Record Identifier
- 9984693978702771
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