Aspirin for everyone over 50? Avoid the harm

ABSTRACT

Editor—The recommendation that everyone over 50 should take aspirin ignores the issue of dose with its ratio of benefit to risk, given that a person still has at least a third of life span remaining and that older hypertensive patients are susceptible to haemorrhagic stroke.1 The debate about what is a low dose has gone on long enough, with no definite answer beyond 75 mg to over four times its multiple at 325 mg for secondary prevention of cardiovascular and cerebrovascular thrombotic disease. Aspirin across the board for primary prevention may be considered in patients with a 10 percent risk of coronary heart disease, and the risk-benefit balance between the number of myocardial infarctions that can be prevented and the risk of haemorrhagic stroke and gastrointestinal bleeds must be taken into account.