Aspirin in people with dementia, long-term benefits and harms: A systematic review

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Abstract

Purpose: People with dementia may have indications for aspirin prescription and clinicians are asked to balance the potential risks against benefits. This review examines the evidence for risk and benefit of long-term aspirin use in people with dementia aged over 65 years, including randomised controlled trials and observational studies.

Methods: We searched three databases for research published between 2007 to 2019. Each eligible article was assessed for risk of bias, and confidence in findings was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results: Four papers met inclusion criteria, one randomised controlled trial, two cohort study, and one with pooled data. All looked only at dementia of the Alzheimer's type, and none addressed myocardial or cerebral infarction as outcomes. Dementia progression was reported by two studies, with conflicting results. The trial found no significant effect of aspirin on mortality (odds ratio aspirin vs no aspirin 1.07, 95% confidence interval 0.58-1.97) but found more events of severe bleeding with aspirin (OR aspirin vs no aspirin 6.9, 1.5-31.2). An excess in intracranial haemorrhage in the aspirin group was judged plausible based on two non-randomised studies.

Conclusions: The review findings are limited because studies include only people with Alzheimer's type dementia and lack confirmatory studies, although an increased risk of bleeding events is recognised. Further research that addresses the benefits and risks of aspirin in more representative groups of people with dementia is needed to guide prescribing decisions.
Original languageEnglish
JournalEuropean Journal of Clinical Pharmacology
DOIs
Publication statusAccepted/In press - 11 Jan 2021

Keywords

  • Dementia
  • Aspirin
  • Prescribing
  • Multimorbidity

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