Real-world data links low-dose aspirin use to increased anemia risk among older adults

 With your already high risk of anemia your competent? doctor should be knowledgeable about anemia prevention and detection protocols. Do you have a functioning stroke doctor or not? I've been taking a full dose aspirin now for 18 years now and before my blood donations I have to take iron pills to pass the hemoglobin test.

Impact of anemia on acute ischemic stroke outcomes: A systematic review of the literature January 2023

This line from there: Anemia has been reported in nearly 40% of acute ischemic stroke (AIS) patients and is linked to significant morbidity and disability.

The latest here:

Real-world data links low-dose aspirin use to increased anemia risk among older adults

Key takeaways:

• Older adults exposed to low-dose aspirin had a higher risk for anemia and hematinic deficiency compared with those who were not exposed.
• Anemia among older adults occurred independently of major bleeding.

Low-dose aspirin use was significantly associated with an increased risk for anemia among older Danish adults in a real-world setting, according to a study published in European Heart Journal – Quality of Care and Clinical Outcomes.

As Healio previously reported, a post hoc analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial revealed that daily intake of low-dose aspirin was linked to an increased incidence of anemia among healthy older adults.

Older adults exposed to low-dose aspirin had a higher risk for anemia and hematinic deficiency compared with those who were not exposed. Image: Adobe Stock

“While data from the ASPREE trial have contributed with valuable evidence, there remains a notable gap in our understanding of the real-world impact of low-dose aspirin for both primary and secondary prevention [of CVD] in relation to the risk of anemia,” Maria Antonietta Barbieri, a PhD student in the department of drug design and pharmacology at the University of Copenhagen in Denmark and the department of clinical and experimental medicine at the University of Messina in Italy, and colleagues wrote.

To address this gap, Barbieri and colleagues conducted a registry-based cohort study to assess risk for developing anemia among older Danish adults exposed to low-dose aspirin.

They used several Danish registers to identify 313,508 older adults (median age, 73.1 years; 57.7% women) who redeemed their first low-dose aspirin prescription (75 mg or 100 mg) for the primary or secondary prevention of CV events between 2008 and 2013. Of this cohort, 19.1% were exposed to low-dose aspirin during the study period, and the remaining 80.9% were identified as nonusers.

The primary outcome was incidence of anemia — defined as hemoglobin levels less than 12.9 g/dL for men and less than 11.3 g/dL for women — or incidence of hematinic deficiency based on initiation of antianemic treatment during the 5-year follow-up. Secondary outcomes included the occurrence of major bleeding and trend of hemoglobin during follow-up.

The researchers stratified adults who developed anemia as having mild (10 g/dL to lower limit of normal), moderate (8 g/dL-9.9 g/dL) or severe (< 8 g/dL) anemia.

Overall, anemia occurred in 5.9% of adults who were exposed to low-dose aspirin compared with 3.1% of adults who were not exposed (incidence rate ratio [IRR] = 7.89; 95% CI, 7.58-8.21), according to the researchers.

Specifically, mild anemia occurred in 3.9% of adults who were exposed to low-dose aspirin compared with 2.2% of adults who were not exposed, whereas severe anemia occurred in 1.3% of adults who were exposed to low-dose aspirin compared with 0.6% of adults who were not exposed.

Among adults treated with low-dose aspirin who developed anemia, the median reduction in hemoglobin levels was 0.44 g/dL for those with mild anemia, 2.15 g/dL for those with moderate anemia and 13.93 g/dL for those with severe anemia, according to the study

The researchers observed a similar trend for ferritin levels among adults exposed to low-dose aspirin who developed anemia, with a median reduction of 37 µg/L for those with mild anemia, 41 µg/L for those with moderate anemia and 44 µg/L for those with severe anemia.

Additionally, they found that 9.6% of adults exposed to low-dose aspirin had a hematinic deficiency compared with 3.7% of those who were not exposed (IRR = 9.11; 95% CI, 8.81-9.41), and 10.6% of adults exposed to low-dose aspirin experienced major bleeding compared with 3.7% of those who were not exposed (IRR = 10.56; 95% CI, 10.23-10.9).

Barbieri and colleagues noted that only 21.5% of adults who experienced anemia also experienced bleeding, and posited that most anemia events were independent of major bleeding.

“These findings underscore the significance of continuous, long-term monitoring for individuals prescribed low-dose aspirin, allowing a more comprehensive understanding of the evolving risks of anemia associated with this medication,” the researchers wrote. “Health care providers should carefully weigh the risks and benefits of low-dose aspirin, particularly in older populations, and diligently monitor the occurrence of anemia. This proactive approach is essential to strike the optimal balance between potential advantages and associated risks.”

The researchers acknowledged several study limitations, including its observational nature, which creates the potential for biases.

Published by:

Sources/Disclosures

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Source:

Barbieri MA, et al. Eur Heart J Qual Care Clin Outcomes. 2024;doi:10.1093/ehjqcco/qcae089.

Disclosures: Barbieri reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.       

Liberal Blood Transfusion After Traumatic Brain Injury May Hold Benefit

 This is why this research should be done in stroke survivors, not just TBI. But NOTHING WILL OCCUR. We don't have two functioning brain cells anywhere in stroke medical leadership!

Of course your competent? doctor started working on stroke anemia 7 years ago! But you don't have a functioning stroke doctor, do you?

• anemia (2 posts to August 2016)

Impact of anemia on acute ischemic stroke outcomes: A systematic review of the literature

This line from there: Anemia has been reported in nearly 40% of acute ischemic stroke (AIS) patients and is linked to significant morbidity and disability.

The latest here on TBI but should translate to stroke:

Liberal Blood Transfusion After Traumatic Brain Injury May Hold Benefit

Trial didn't meet primary outcome, but functional independence scores were better

by Judy George, Deputy Managing Editor, MedPage Today June 13, 2024

Key Takeaways

• A liberal blood transfusion strategy didn't reduce the risk of an unfavorable neurologic outcome at 6 months in critically ill patients with traumatic brain injury.
• However, it did lead to higher scores in some, but not all, measures of functional independence and quality of life.
• Transfusion strategy was not associated with either mortality or depression.

A liberal blood transfusion strategy didn't reduce the risk of an unfavorable neurologic outcome at 6 months in critically ill patients with traumatic brain injury (TBI) but showed other possible benefits, the HEMOTION trial found.

An unfavorable outcome occurred in 68.4% of the liberal-strategy group and 73.5% of the restrictive-strategy group (adjusted difference 5.4 percentage points, 95% CI -2.9 to 13.7), according to Alexis Turgeon, MD, of CHU de Québec-Université Laval in Canada, and co-authors.

However, the liberal strategy was tied to higher scores in some, but not all, measures of functional independence and quality of life, the researchers reported in the New England Journal of Medicine. The findings were presented simultaneously at the Critical Care Reviewsmeeting in Belfast, Ireland.

Outcomes significantly favored the liberal group for the following secondary endpoints, with differences compared with restrictive transfusion of:

• 4.34 points in overall Functional Independence Measure scores
• 5.19 points in EuroQol visual analogue scale scores
• 0.06 points in the EuroQol five-dimension, five-level utility index scores

Between group differences were not significant for Quality of Life after Brain Injury scores or Patient Health Questionnaire-9 scores for depression. Minimally important differences for TBI have not been established for these measures and no adjustment was made for multiple comparisons, the researchers noted.

"The combined incidence of death and major disability was not statistically different between the two groups, but seemed [to be] favoring the liberal strategy in all analyses," Turgeon said in a statement.

"In light of the overall results of our study and considering the safety of current blood transfusions, the liberal strategy is probably the option that should be preferred in the acute phase of care to improve long-term prognosis following TBI," he suggested. "By improving oxygen transport to the brain during the acute phase of care, it may be possible to save more nerve cells in the days following a TBI, thereby preventing additional brain damage."

Anemia develops in most critically ill patients with TBI and may reduce oxygen to the brain and contribute to poor outcomes. Trials of transfusion strategies in critically ill adults and children showed no mortality benefit in maintaining high hemoglobin levels.

"However, these trials included very few patients with neurologic injuries and focused on mortality; they thus provide insufficient guidance for the care of patients with traumatic brain injury, for whom long-term neurologic function is the most important outcome," Turgeon and co-authors wrote.

"Clinical guidelines and reviews comparing the effects of liberal transfusion strategies with those of restrictive transfusion strategies emphasize that current data are not sufficient to guide transfusion practices in patients with traumatic brain injury," they added.

From September 2017 to April 2023, HEMOTION randomized 742 adults with moderate or severe TBI and anemia to receive transfusion of red cells according to a liberal strategy (transfusions triggered by a hemoglobin level ≤10 g/dL) or a restrictive strategy (transfusions started at a hemoglobin ≤7 g/dL). The study was conducted in 34 hospitals in Canada, the United Kingdom, France, and Brazil.

Trial inclusion criteria specified a Glasgow Coma Scale score of 3 to 12 (scores range from 3 to 15, and lower scores indicate lower levels of consciousness). Most participants were men (72.7%), the mean age was about 48, and 73.2% had severe traumatic brain injury. More than two-thirds had extracranial injuries.

The primary endpoint was an unfavorable outcome at 6 months on the Glasgow Outcome Scale-Extended (GOS-E). Scores on this scale range from 1 (death) to 8 (a full return to normal life). HEMOTION researchers defined an unfavorable outcome using a sliding dichotomy of GOS-E scores, according to the prognosis of each patient at baseline. Secondary outcomes included mortality, functional independence, quality of life, and depression at 6 months.

The relative risk of an unfavorable GOS-E outcome in the liberal group versus the restrictive group was 0.93 (95% CI 0.83-1.04). Findings were consistent across patients with the worst, intermediate, and best predicted prognoses and in sensitivity analyses.

Mortality was 26.8% in the liberal group and 26.3% in the restrictive group at 6 months. Venous thromboembolic events occurred in 8.4% of each group. Acute respiratory distress syndrome emerged in 3.3% of the liberal-approach group and 0.8% of the restrictive group.

The trial recruited only patients with anemia, which is a population that tends to have more severe TBI at baseline, Turgeon and co-authors noted. "Detection of small treatment effects becomes more challenging as the baseline risk increases," they observed. In addition, the liberal and restrictive groups had some imbalances at baseline.

• Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

Disclosures

The HEMOTION trial was funded by the Canadian Institutes of Health Research and others.

Turgeon reported being the Canada Research Chair in Critical Care Neurology and Trauma.

Co-authors disclosed relationships with academic institutions, non-profit groups, and industry.

Primary Source

New England Journal of Medicine

Source Reference: opens in a new tab or windowTurgeon AF, et al "Liberal or restrictive transfusion strategy in patients with traumatic brain injury" N Engl J Med 2024; DOI: 10.1056/NEJMoa240436.