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Does aspirin lead to anemia?

Did you know anemia in the older population can be linked to a daily dose of aspirin?


“Low-dose aspirin increased incident anemia and decline in ferritin in otherwise healthy older adults, independent of major bleeding.” This is the conclusion of June 2023, research report in the Annals of Internal Medicine. A further conclusion was that “periodic monitoring of hemoglobin should be considered in older persons on aspirin.”


Ferritin is a blood protein that contains iron and releases it when the body needs it. Iron is a mineral in red blood cells that carries oxygen through the body and releases it when the body needs it. A ferritin test reveals if the blood ferritin level is lower than normal, indicating you have an iron deficiency.


Research was done in both the U.S. and Australia, funded by the NIH and Australian National Health and Medical Research Council, on 70 Year or older White and 65 and older for Black and Hispanic persons.


Anemia in older people—likely caused in this case by aspirin-induced bleeding, such as blood loss in stool—is tied to outcomes including functional decline, fatigue, and higher mortality. The findings therefore reinforce new guidelines that promote aspirin as a tool for secondary—not primary—prevention of cardiovascular disease in older people, and support regular monitoring of hemoglobin in patients who use the drug, the researchers wrote in the Annals of Internal Medicine.


Taking a 100-mg dose of aspirin each day was associated with a 20% higher risk of anemia compared with a placebo, according to a secondary analysis of results from the ASPREE (Aspirin in Reducing Events in the Elderly) randomized clinical trial that included 19 114 people aged 65 years or older. The incidence of anemia was about 51 events per 1000 person-years in the aspirin group and 43 events in the placebo group. Participants who received daily aspirin also tended to have a larger decrease in ferritin levels—a measure of overall iron stores—and in hemoglobin concentration over 3 and 5 years, respectively. Source: June 28, 2023. doi:10.1001/jama.2023.11954

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