• Zoe K McQuilten, Le Thi Phuong Thao, Sant-Rayn Pasricha, Andrew S Artz, Michael Bailey, Andrew T Chan, Harvey Jay Cohen, Jessica E Lockery, Anne M Murray, Mark R Nelson, Hans G Schneider, Rory Wolfe, Robyn L Woods, Erica M Wood, and John J McNeil.
• 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.).
• Ann. Intern. Med. 2023 Jul 1; 176 (7): 913921913-921.

BackgroundDaily low-dose aspirin increases major bleeding; however, few studies have investigated its effect on iron deficiency and anemia.ObjectiveTo investigate the effect of low-dose aspirin on incident anemia, hemoglobin, and serum ferritin concentrations.DesignPost hoc analysis of the ASPREE (ASPirin in Reducing Events in the Elderly) randomized controlled trial. (ClinicalTrials.gov: NCT01038583).SettingPrimary/community care in Australia and the United States.ParticipantsCommunity-dwelling persons aged 70 years or older (≥65 years for Black persons and Hispanic persons).Intervention100 mg of aspirin daily or placebo.MeasurementsHemoglobin concentration was measured annually in all participants. Ferritin was measured at baseline and 3 years after random assignment in a large subset.Results19 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.LimitationsHemoglobin was measured annually. No data were available on causes of anemia.ConclusionLow-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.Primary Funding SourceNational Institutes of Health and Australian National Health and Medical Research Council.

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