Short- and long-term impact of aspirin cessation in older adults: a target trial emulation
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Date
2024
Authors
Zhou, Z.
Webb, K.L.
Nelson, M.R.
Woods, R.L.
Ernst, M.E.
Murray, A.M.
Chan, A.T.
Tonkin, A.
Reid, C.M.
Orchard, S.G.
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Journal article
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BMC Medicine, 2024; 22(1):306-1-306-11
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Zhen Zhou, Katherine L. Webb, Mark R. Nelson, Robyn L. Woods, Michael E. Ernst, Anne M. Murray, Andrew T. Chan, Andrew Tonkin, Christopher M. Reid, Suzanne G. Orchard, Brenda Kirpach, Raj C. Shah, Nigel Stocks, Jonathan C. Broder, and Rory Wolfe
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Abstract
Background The net beneft 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 longterm follow-up, aspirin cessation versus continuation was not associated with elevated risk of CVD, MACE, and allcause 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 fndings 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 fndings suggest that deprescribing prophylactic aspirin might be safe in healthy older adults with no known CVD.
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© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.