Low-dose aspirin use associated with 20% increased anemia risk in older adults

1. Low-dose aspirin use associated with 20% increased anemia risk in older adults
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0675
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An analysis of the ASPREE (ASPirin in Reducing Events in the Elderly) trial found that the use of low-dose aspirin was associated with a 20 percent increased incidence of anemia and decline in ferritin, or blood iron levels, in otherwise healthy older adults. These findings suggest that periodic monitoring of hemoglobin should be considered in older patients taking aspirin. The analysis is published in Annals of Internal Medicine.

Approximately half of older persons in the United States have reported preventative aspirin use. One of the complications of aspirin use is an increased risk for major bleeding, particularly gastrointestinal bleeding. Although the risk for overt bleeding due to aspirin has been well characterized, very few studies have measured the effect of aspirin on anemia, particularly in older populations.

Researchers from Monash University, Melbourne conducted a post-hoc analysis of the ASPREE randomized controlled trial. The trial included 19,114 persons aged 70 years or older who were randomly assigned to take 100 mg of aspirin daily or placebo. Hemoglobin was measured annually, and ferritin was measured at baseline and 3 years after randomization. The data showed that the risk for developing anemia was 23.5 percent among those assigned to receive low-dose aspirin. These results were accompanied by a small but greater decrease in mean hemoglobin and a greater decline in ferritin concentrations among those receiving aspirin. Differences in clinically significant bleeding events did not account for the overall difference in incident anemia or the decline in ferritin observed in ASPREE but was most likely due to occult blood loss given the observed steeper decline in ferritin in participants allocated to aspirin.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with NIA experts about the specific findings of this paper and/or the broad view of NIA-funded research, please contact the NIA communications office at 301-496-1752 or NIAPressTeam@mail.nih.gov.
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2. Acupuncture and doxylamine–pyridoxine beneficial for moderate to severe nausea and vomiting during pregnancy
Abstract: https://www.acpjournals.org/doi/10.7326/M22-2974
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A randomized, controlled, double-blinded trial involving more than 350 pregnant women found that the use of acupuncture or doxylamine-pyridoxine relieved moderate to severe nausea and vomiting during pregnancy. Using both treatments offered even greater relief. The study is published in Annals of Internal Medicine.

Nausea and vomiting impacts up to 85 percent of pregnant women. While 80 to 90 percent of those cases are mild, severe nausea and vomiting, or hyperemesis gravidarum (HG), develops in 10 percent of cases. In addition, up to 10 percent of wanted pregnancies that are complicated by HG are terminated because of intolerable symptoms and complications. Despite the need for an effective treatment and hesitation of medication amongst pregnant women, very few recommendations can be made about optimal and alternative treatments because of inadequate sample sizes and poor study quality.

Researchers from First Affiliated Hospital, Heilongjiang University of Chinese Medicine, and Heilongjiang Provincial Hospital, Harbin, China randomly assigned 352 women in early pregnancy with moderate to severe nausea and vomiting to receive daily active or sham acupuncture for 30 minutes and/or doxylamine-pyridoxine or placebo for 14 days to assess the efficacy and safety of either intervention or the combination of both. The authors found that active acupuncture and doxylamine–pyridoxine were modestly superior to sham acupuncture and placebo, respectively, in reducing the severity symptoms and improving quality of life among pregnant women. However, combination of both treatments offered numerically larger benefits than each treatment alone. The authors note that antinausea drugs may be underprescribed by general practitioners because of concerns about potential risks for birth defects. Acupuncture could serve as an alternative for patients who are unwilling to use pharmacologic treatments during pregnancy.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Xiao-Ke Wu, MD, PhD, please contact Wu Qi Ph.D at wuqidonice@qq.com or via WeChat at wuqidonice_57.
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3. Complicated dengue rare in travelers, but doctors should be aware of the warning signs
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0721
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A retrospective analysis of almost 6,000 persons with dengue found that while only 2 percent of cases were considered complicated, almost all complicated cases had warning signs. The authors advise that clinicians should monitor patients with dengue closely for warning signs that may indicate progression to severe disease. The analysis is published in Annals of Internal Medicine.

Dengue is the leading cause of acute undifferentiated febrile illness among travelers returning to Europe from all continents except Africa. Severe dengue can lead to bleeding, shock, or organ failure. The 2009 World Health Organization (WHO) dengue classification distinguishes dengue with warning signs and severe dengue. Warning signs in a patient with dengue include abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement, and increasing hematocrit with decreasing platelets. Recognition of these warning signs may facilitate timely triage of patients at risk for severe dengue.

Researchers from GeoSentinel (https://geosentinel.org/), the emerging infectious diseases surveillance and research network of the U.S. Centers for Disease Control and Prevention (CDC) and the International Society of Travel Medicine (ISTM), conducted a retrospective chart review and analysis of 5,958 patients with dengue reported to the Network from January 2007 through July 2022, to describe the epidemiology, clinical characteristics, and outcomes among international travelers with severe dengue or dengue with warning signs as defined by the 2009 World Health Organization classification. The researchers found that only 2 percent of cases were reported as complicated dengue. However, 99 percent of the patients with complicated dengue that completed a supplemental questionnaire had warning signs, and 31 percent were classified as severe. According to the authors, clinicians should monitor travelers with dengue closely for laboratory findings and signs that may indicate progression to severe disease, even if the predictive value of warning signs in travelers has not been fully validated.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Ralph Huits, MD, PhD, please email the GeoSentinel press office at geosentinel@geosentinel.org.
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