Aspirin Use by the Elderly - Why and How Much? / האספירין בגיל הזיקנה - למה וכמה?

Aspirin was first described in the 18th Century and since 1899 has been manufactured synthetically. In 1969 its anti-thrombotic effect was discovered and by 1971 it was shown to have an antiprostaglandin effect. The pharmacokinetics of the drug are described but little emphasis in the literature was placed on the pharmacodynamic changes occurring in the elderly. The side effects are well known and the literature emphasises the fact that the side effects are often dose dependent. Aspirin use has decreased and almost ceased as an antipyretic or antirheumatoidal but has increased in use as an anti-thrombotic. In 1988 the Antiplatelet Trialists' Collaboration Study published the summary results of 25 studies around the world. Their conclusion was that there is a trend for a generalised 25% decrease in vascular events with the use of aspirin. However, as the age increases there is an increase in the number and severity of the side effects. Aspirin also has been described for use in preventing cataract development in diabetics, migraine attacks, and colonic cancer. The efficacy of its use in the above cases is still debatable. Aspirin treatment has been compared to the use of coumadin in preventing stroke and though the later was more beneficial there was a high non-compliance amongst the elderly because of the inconvenience of requiring close monitoring. No studies have reported the use of low dose coumadin compared to aspirin. The dosage for aspirin has decreased over the years from 1000mg down to as low as 75mg per day with a concommitant decrease in the side effects. The side effects of ticlopidine, a new drug on the market are only now being reported in literature. In conclusion, the use of aspirin has its benefits if there is a risk factor present, but if there is no benefit or side effects appear, then the treatment should be stopped. The lower the dose, the lesser are the side effects. However as of yet, there is no agreement amongst the investigators as to the correct dosage.