What are the guidelines for aspirin (acetylsalicylic acid) use in a 90-year-old individual?

From the Guidelines

Aspirin use in a 90-year-old individual is generally not recommended for primary prevention of cardiovascular disease due to increased bleeding risks that outweigh potential benefits. According to the U.S. Preventive Services Task Force recommendation statement 1, the balance of benefits and harms of initiating aspirin use in adults aged 70 years or older, including 90-year-olds, could not be assessed. Key considerations include:

• Baseline CVD risk: A CVD risk threshold of 10% should prompt a discussion about aspirin use, but this is more relevant to younger adults 1.
• Age: Adults aged 70 years or older who are currently taking aspirin should discuss with their clinician whether they should continue, as the benefits of aspirin use in this age group are uncertain 1.
• Bleeding risk: Factors that increase bleeding risk in elderly patients, such as concurrent use of anticoagulants or NSAIDs, history of gastrointestinal bleeding, uncontrolled hypertension, and certain comorbidities, should be carefully evaluated.
• Secondary prevention: Low-dose aspirin (usually 81 mg daily) may be appropriate for secondary prevention in 90-year-olds with established cardiovascular disease, but only if bleeding risk is low and under medical supervision. Regular monitoring for signs of bleeding and periodic reassessment of the need for aspirin by a healthcare provider are essential for 90-year-old individuals taking aspirin 1.

From the Research

Guidelines for Aspirin Use in a 90-Year-Old Individual

• The use of aspirin for primary prevention of cardiovascular disease in adults aged 90 years is not recommended, as the risk of bleeding outweighs the potential benefits 2.
• A study published in The New England Journal of Medicine found that the use of low-dose aspirin as a primary prevention strategy in older adults resulted in a significantly higher risk of major hemorrhage and did not result in a significantly lower risk of cardiovascular disease than placebo 2.
• The US Preventive Services Task Force (USPSTF) recommends against initiating low-dose aspirin use for the primary prevention of cardiovascular disease in adults 60 years or older, as the net benefit is small and the risk of bleeding is high 3.
• The decision to initiate aspirin therapy should be made on a case-by-case basis, taking into account the individual's risk factors, preferences, and medical history 4, 3.
• Clinicians should use their judgment in weighing the risks and benefits of aspirin therapy, while considering the patient's preferences and values 4, 3.

Key Considerations

• The risk of bleeding increases with age, and older adults are more likely to experience major hemorrhage as a result of aspirin therapy 2.
• The net benefit of aspirin use for primary prevention of cardiovascular disease is small, and the risk of bleeding should be carefully considered before initiating therapy 3.
• Individualized assessment of benefits and risks is essential, and clinicians should use tools such as the Aspirin-Guide to help make informed decisions 5.

Age-Specific Recommendations

• Adults aged 40-59 years with a 10% or greater 10-year cardiovascular disease risk may benefit from aspirin therapy, but the decision should be made on a case-by-case basis 4, 3.
• Adults aged 60 years or older should not initiate low-dose aspirin use for primary prevention of cardiovascular disease, as the net benefit is small and the risk of bleeding is high 3.