Department of Clinical Geratology, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
BMC Geriatr. 2010 Sep 29;10:71. doi: 10.1186/1471-2318-10-71.
Overt bleeding associated with low dose aspirin (LDA) is well-recognized, little attention is given to the possibility of association between LDA and occult bleeding, although this is known to occur in healthy volunteers. LDA is used increasingly in primary and secondary prevention of a number of medical conditions, many of which are common in older people, as is anemia. Anemia in older people is associated with adverse outcomes including disability, morbidity and mortality. The purpose of this study was to review the evidence that LDA might cause anemia without overt bleeding.
An extensive narrative review was carried out. Electronic searching (including database links) and reference lists of reports were used to identify studies reporting on use of aspirin ≤325 mg/day and anemia or change in hemoglobin (Hb) without overt bleeding. Data were extracted from reports of trials, adverse drug reactions (ADRs) and prevalence studies of adults aged ≥18 years, published since 1980.
There are few relevant data, with considerable heterogeneity among trial designs, duration, and patient characteristics in studies of LDA. In five randomised trials (n = 5879) in (mostly secondary) prevention, the majority of patients were men without peptic ulcer disease aged 50-70 years and no consistent association between LDA and change in Hb was found. In two smaller studies (n = 609) of primary prevention in healthy patients aged ≥70 years, there was a small but statistically significant fall in Hb with LDA. Observational studies, and data from trials in which use of LDA was not a primary focus of the study, were inconclusive.
It is not clear whether there is an association between LDA and anemia in the absence of overt bleeding, but there may be an association between LDA and fall in Hb in (a subset of) older patients. The available evidence has significant limitations, which are discussed; studies including more older patients, and publication of individual patient data, would help clarify this important matter.
低剂量阿司匹林（LDA）相关的显性出血是众所周知的，尽管在健康志愿者中也存在隐性出血的可能性，但对此关注甚少。LDA 越来越多地用于多种医疗条件的一级和二级预防，其中许多情况在老年人中很常见，贫血也是如此。老年人贫血与不良结局相关，包括残疾、发病和死亡。本研究旨在综述 LDA 可能导致无显性出血性贫血的证据。
进行了广泛的叙述性综述。电子搜索（包括数据库链接）和报告的参考文献被用来确定报告使用 ≤325mg/天的阿司匹林和贫血或血红蛋白（Hb）变化而无显性出血的研究。数据从自 1980 年以来发表的试验报告、药物不良反应（ADR）和成人患病率研究中提取，年龄≥18 岁。
相关数据很少，在 LDA 的研究中，试验设计、持续时间和患者特征存在很大的异质性。在五项（主要是二级）预防的随机试验中（n=5879），大多数患者为没有消化性溃疡病的男性，年龄在 50-70 岁之间，未发现 LDA 与 Hb 变化之间存在一致的关联。在两项较小的（n=609）针对健康老年患者的一级预防研究中，LDA 使 Hb 略有但具有统计学意义的下降。观察性研究和不是研究重点的试验数据结果并不明确。
目前尚不清楚在无显性出血的情况下，LDA 是否与贫血有关，但 LDA 可能与（一部分）老年患者的 Hb 下降有关。现有的证据存在重大局限性，我们对其进行了讨论；包括更多老年患者的研究和个体患者数据的发表将有助于澄清这一重要问题。
