People above the age of 50 without excess bleeding risk
should take low-dose daily aspirin (75 to 100 mg) as per the current
recommendations.
Patients who are more concerned about the bleeding risks
than the potential benefits (prevention of cardiovascular events and cancer)
may reasonably choose to not take aspirin for primary prevention.
Meta-analyses of randomized trials have shown aspirin to
reduce the risk of non-fatal myocardial infarction (Arch Intern Med 2012;
172:209) and long-term aspirin use reduces overall cancer risk (Lancet 2012;
379:1602).
A meta-analysis addressing this combined outcome suggests
that aspirin use in 1000 average risk patients at age 60 years would be
expected to result, over a 10-year period, in six fewer deaths, 19 fewer
non-fatal myocardial infarctions, 14 fewer cancers, and 16 more major bleeding
events.
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