School of Public Health and Preventive Medicine, Monash University; Department of Haematology, Monash Health; and Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia (Z.K.M.).
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.T.P.T., R.W., R.L.W., J.J.M.).
Ann Intern Med. 2023 Jul;176(7):913-921. doi: 10.7326/M23-0675. Epub 2023 Jun 20.
Daily low-dose aspirin increases major bleeding; however, few studies have investigated its effect on iron deficiency and anemia.
To investigate the effect of low-dose aspirin on incident anemia, hemoglobin, and serum ferritin concentrations.
Post hoc analysis of the ASPREE (ASPirin in Reducing Events in the Elderly) randomized controlled trial. (ClinicalTrials.gov: NCT01038583).
Primary/community care in Australia and the United States.
Community-dwelling persons aged 70 years or older (≥65 years for Black persons and Hispanic persons).
100 mg of aspirin daily or placebo.
Hemoglobin concentration was measured annually in all participants. Ferritin was measured at baseline and 3 years after random assignment in a large subset.
19 114 persons were randomly assigned. Anemia incidence in the aspirin and placebo groups was 51.2 events and 42.9 events per 1000 person-years, respectively (hazard ratio, 1.20 [95% CI, 1.12 to 1.29]). Hemoglobin concentrations declined by 3.6 g/L per 5 years in the placebo group and the aspirin group experienced a steeper decline by 0.6 g/L per 5 years (CI, 0.3 to 1.0 g/L). In 7139 participants with ferritin measures at baseline and year 3, the aspirin group had greater prevalence than placebo of ferritin levels less than 45 µg/L at year 3 (465 [13%] vs. 350 [9.8%]) and greater overall decline in ferritin by 11.5% (CI, 9.3% to 13.7%) compared with placebo. A sensitivity analysis quantifying the effect of aspirin in the absence of major bleeding produced similar results.
Hemoglobin was measured annually. No data were available on causes of anemia.
Low-dose aspirin increased incident anemia and decline in ferritin in otherwise healthy older adults, independent of major bleeding. Periodic monitoring of hemoglobin should be considered in older persons on aspirin.
National Institutes of Health and Australian National Health and Medical Research Council.
每日低剂量阿司匹林会增加大出血风险；然而，很少有研究调查其对缺铁和贫血的影响。
调查低剂量阿司匹林对缺铁性贫血、血红蛋白和血清铁蛋白浓度的影响。
ASPREE（阿司匹林减少老年人事件）随机对照试验的事后分析。（ClinicalTrials.gov：NCT01038583）。
澳大利亚和美国的初级/社区护理。
年龄在 70 岁或以上的社区居民（黑人或西班牙裔为 65 岁或以上）。
每天服用 100 毫克阿司匹林或安慰剂。
所有参与者每年测量一次血红蛋白浓度。铁蛋白在随机分组后 3 年进行基线和测量。
共有 19114 人被随机分配。阿司匹林组和安慰剂组的贫血发生率分别为 51.2 例和 42.9 例/1000 人年（风险比，1.20[95%CI，1.12 至 1.29]）。安慰剂组血红蛋白浓度每 5 年下降 3.6 g/L，而阿司匹林组每 5 年下降 0.6 g/L（CI，0.3 至 1.0 g/L）。在基线和第 3 年有铁蛋白测量值的 7139 名参与者中，与安慰剂组相比，阿司匹林组在第 3 年时铁蛋白水平低于 45μg/L 的比例更高（465[13%]比 350[9.8%]），铁蛋白总体下降幅度更大，为 11.5%（CI，9.3%至 13.7%）。一项定量分析阿司匹林在没有大出血情况下的效果的敏感性分析得出了类似的结果。
血红蛋白每年测量一次。没有关于贫血原因的数据。
低剂量阿司匹林增加了健康老年人缺铁性贫血的发生率和铁蛋白的下降，而与大出血无关。阿司匹林使用者应定期监测血红蛋白。
美国国立卫生研究院和澳大利亚国家卫生和医学研究理事会。
