Risk of Iron-Deficiency Anemia Could be 23% Higher for Older Adults Taking Low-Dose Aspirin

The study results suggest the risk for developing anemia was 23.5% among those assigned to receive low-dose aspirin.

In a press release, the researchers say differences in clinically significant bleeding events did not account for the overall difference in anemia or the decline in iron levels observed in ASPREE.

Healthline spoke to Dr. Basil A. Eldadah, chief of the Geriatrics Branch at the division of Geriatrics and Clinical Gerontology at the National Institute on Aging to better understand what this finding means for people taking aspirin later in life.

“The paper’s findings suggest that doctors should consider periodically monitoring hemoglobin levels in their patients on aspirin. Blood ferritin levels might be one of the measures in addition to others that could help identify a cause of any possible anemia,” he says.

“Periodic monitoring of hemoglobin levels may be particularly important in individuals taking aspirin who are at higher risk of anemia, such as those with chronic diseases like cancer, chronic kidney disease, diabetes, heart failure, and others,” he adds.

“The US Preventive Services Task Force currently recommends against taking low-dose aspirin for people 60 years old or older for primary prevention of cardiovascular disease, and the findings of this paper suggest another reason why aspirin in this population might be avoided,” says Eldadah to Healthline.

“Finally, the caveat with all these recommendations is that both individuals on aspirin and those who are contemplating taking aspirin should consult with their doctors about the risks and benefits of taking aspirin,” he says.

“Aspirin use has been associated with an increased risk of gastrointestinal bleeding, which can potentially contribute to anemia in older adults,” says Dr. David Cutler, family medicine physician at Providence Saint John’s Health Center in Santa Monica, California.

“Gastrointestinal bleeding occurs when there is damage or irritation to the lining of the stomach or intestines, leading to blood loss,” he explains.

“Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can inhibit the production of certain substances in the body that promote inflammation and blood clotting,” he adds. “While aspirin is commonly used to prevent heart attacks and strokes, its use can increase the risk of gastrointestinal bleeding.”

Jennifer Bourgeois, PharmD, SingleCare’s Health and Pharmacy Expert, explains it in more detail, explaining the substances that reduce inflammation and pain are known as prostaglandins.

“Prostaglandins are chemical compounds that are involved in physiological processes such as inflammation and pain,” explains Bourgeois. “Aspirin specifically works by inhibiting the activity of the enzyme cyclooxygenase (COX), which leads to a reduction in the production of prostaglandins and, as a result, a decrease in inflammation and pain. Aspirin also has antithrombotic properties, which means it can help prevent blood clots and reduce the risk of heart attack and stroke,” she adds.

Bourgeois adds that NSAIDS can cause mucosal injury to the GI lining resulting in bleeding that may or may not be apparent. This bleeding can result in iron deficiency anemia over time.

Cutler says anemia can result in fatigue, weakness, shortness of breath, and other symptoms due to the reduced oxygen-carrying capacity of the blood.

In older adults, Cutler says the association between aspirin use and anemia is primarily related to the increased risk of gastrointestinal bleeding.

“When there is chronic or recurrent bleeding from the gastrointestinal tract, it can lead to iron-deficiency anemia, as iron is necessary for the production of hemoglobin in red blood cells. The chronic blood loss can deplete iron stores in the body, resulting in anemia over time,” he tells Healthline.

“It’s important to note that not all older adults who use aspirin will develop anemia, and the risk varies depending on several factors such as the individual’s overall health, dose and duration of aspirin use, and any other underlying conditions they may have,” Cutler adds.

Cutler says there are alternative medications available that may have a lower risk of gastrointestinal bleeding, as well as protective medication to prevent bleeding when aspirin or other NSAID medication is used.

“The decision on which, if any medication to use requires knowledgeable weighing of risks and benefits as well as considering all alternatives,” he says.

“Alternatives to aspirin would depend on the condition for which aspirin is being used. Some of the common uses of aspirin are for pain, inflammation, and preventing clotting of blood which can lead to heart attacks and strokes,” he explains.

Generally speaking, Cutler says acetaminophen (Tylenol) is an alternative pain medication, ibuprofen (Advil or Motrin) is an alternative NSAID anti-inflammatory, and clopidogrel (Plavix) is an antiplatelet drug that prevents clots.

“It’s a good idea to discuss with your physician why he might be suggesting you take aspirin,” says Cutler.

“Understanding aspirin risks and benefits requires a full understanding of your medical condition, other medications you are taking, and any previous adverse reactions you may have had such as gastrointestinal bleeding or anemia,” he adds.

“Medication use should be discussed with the provider before any changes are made. There are a variety of alternatives depending on the goal of treatment. As always, there should be a risk-benefit analysis to determine the right treatment for each patient,” says Bourgeois.