Safety of ceasing aspirin used without a clinical indication after age 70 years: a subgroup analysis of the ASPREE randomized trial

Background: The ASPREE (ASPirin in Reducing Events in the Elderly) trial was a randomized, double-blind, placebocontrolled primary prevention trial of aspirin in 19114 communitydwelling persons aged 70 years and older (≥65 years in U.S. racial minorities). The results of the trial demonstrated that aspirin had no benefit for disability-free survival, prevention of cardiovascular disease events, or prevention of incident cancer, and increased risk for major bleeding and all-cause mortality (1–3). These findings were interpreted by some as being relevant only to aspirin initiation and not aspirin discontinuation (4). The availability of evidence to inform the risks (for example, forgone cardiovascular protection) and benefits (for example, decreased risk for major hemorrhage) from aspirin cessation among older adults is timely, given updated guideline recommendations regarding aspirin use and clinical uncertainty (5).

Objective: To investigate the effect of aspirin cessation versus continuation on disability-free survival and other clinical outcomes in a post hoc analysis of ASPREE participants who were regularly taking aspirin before trial enrollment.