Premium
Incidence of intracranial bleeds in new users of low‐dose aspirin: a cohort study using The Health Improvement Network
Author(s) -
Cea Soriano L.,
Gaist D.,
SorianoGabarró M.,
García Rodríguez L. A.
Publication year - 2017
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.13686
Subject(s) - medicine , aspirin , incidence (geometry) , cumulative incidence , confidence interval , cohort , low dose aspirin , cohort study , pediatrics , physics , optics
Essentials Intracranial bleeds (ICB) are serious clinical events that have been associated with aspirin use. Incidence rates of ICB were calculated among new‐users of low‐dose aspirin in the UK (2000–2012). Over a median follow‐up of 5.58 years, the incidence of ICB was 0.08 per 100 person‐years. Our estimates are valuable for inclusion in risk–benefit assessments of low‐dose aspirin use.Summary Background Low‐dose aspirin protects against both ischemic cardiovascular ( CV ) events and colorectal cancer ( CRC ). However, low‐dose aspirin may be associated with a slightly increased risk of intracranial bleeds ( ICB s). Objectives To obtain the incidence rates of ICB s overall and by patient subgroups among new users of low‐dose aspirin. Patients/Methods Using The Health Improvement Network ( THIN ) UK primary‐care database (2000–2012), we identified a cohort of new users of low‐dose aspirin aged 40–84 years ( N = 199 079; mean age at start of follow‐up, 63.9 years) and followed them for up to 14 years (median 5.58 years). Incident ICB cases were identified and validated through linkage to hospitalization data and/or review of THIN records with free‐text comments. Incidence rates with 95% confidence intervals ( CI s) were calculated. Results Eight hundred and eighty‐one incident ICB s cases were identified: 407 cases of intracerebral hemorrhage ( ICH ), 283 cases of subdural hematoma ( SDH ), and 191 cases of subarachnoid hemorrhage ( SAH ). Incidence rates per 100 person‐years were 0.08 (95% CI 0.07–0.08) for all ICB s, 0.04 (95% CI 0.03–0.04) for ICH , 0.03 (95% CI 0.02–0.03) for SDH , and 0.02 (95% CI 0.01–0.02) for SAH . The ICB incidence rates per 100 person‐years for individuals with an indication of primary CV disease prevention were 0.07 (95% CI 0.06–0.07) and 0.09 (95% CI 0.08–0.10) for secondary CV disease prevention. Incidence rates were higher in men for SDH , and higher in women for ICH and SAH . Conclusions Our results provide valuable estimates of the absolute ICB risk for incorporation into risk–benefit assessments of low‐dose aspirin use.