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  New evidence of aspirin risk for elderly
Taking aspirin or similar blood-thinning medication may cause minute bleeding in the brains of older adults, say researchers from the Netherlands.

But experts add it's too soon to say whether the risk of taking aspirin outweighs the benefits in healthy older people.

Researchers from the Erasmus MC University Medical Centre, Rotterdam report online this week in the Archives of Neurology the results of a study involving 1062 patients whose average age was about 70 years old.

The researchers found that patients taking aspirin or another anticoagulant drug, carbasalate calcium, appeared more likely than patients who did not use anti-clotting drugs to have bouts of cerebral "microbleeding".

The microbleeding was detected by researchers with the aid of magnetic resonance imaging technology.

The study found that the link between the drugs and microbleeding was particularly pronounced among individuals taking aspirin at higher doses. The drug often is taken as a blood thinner by elderly people to treat or prevent heart disease.

Cerebral microbleeds - sometimes a sign of small-vessel disease and common in the elderly - occur when the walls of blood vessels in the brain become weakened.

The authors say the findings raise questions as to whether patients with cerebral microbleeds who also take aspirin or similar drugs, are at increased risk for even more severe symptomatic brain haemorrhaging.

Professor Bruce Neal, of the medicine department at the University of Sydney says the study is not strong enough to rule out the possibility that factors other than the drugs caused the observed bleeding.

For example, he says factors such as blood pressure and age also influence bleeding and further research is required to confirm that the drugs are to blame.

He also says it is important to weigh up any risks of taking aspirin against the benefits.
Risks worth benefits?

While for many patients, the beneficial effects of anti-clotting drugs for individuals at risk for heart attack and stroke typically outweigh any risks of bleeding, the authors of the Rotterdam study conclude that for some patients "this risk-benefit ratio may differ for certain drugs ... thus influencing treatment decisions."

Australian cardiologist Professor Andrew Tonkin of Monash University in Melbourne agrees.

He says the Rotterdam study is an important piece of evidence in helping to work out if aspirin should be taken routinely by healthy older people.

"It's another piece of evidence that shows aspirin is not without its risks," says Tonkin.

He says many apparently healthy people take aspirin because they believe it will be beneficial.

But, says Tonkin: "The evidence on the relative benefits and risks, particularly in the elderly, at this stage is not as robust as people might anticipate."

Tonkin is involved in a new long-term study, called ASPREE, which aims to help weigh benefits and risks of aspirin.

ASPREE is a double-blind placebo-controlled trial looking at aspirin use in apparently health people over the age of 70, which will help to confirm, or otherwise, the Rotterdam study.

Among other things, it will look at the impact of aspirin on bleeding, cancer and dementia.
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