Linxin Li et al published a prospective population-based cohort study in patients who were receiving antiplatelet drugs for secondary prevention of transient ischaemic attack, ischaemic stroke or myocardial infarction. They determined the type of bleeding, severity, outcome and time course of bleeding which required medical attention.

The risk of major bleeding increased significantly with advancing age (the risk of non-major bleeding was not related to age). Over the age of 75, major upper GIT bleeds were frequently disabling or fatal. Furthermore, if PPIs were used to prevent upper GIT bleeds, the number needed to treat using PPIs routinely to prevent one serious or fatal upper GIT bleed over 5 years fell from 338 for patients younger than 65 to 25 for those older than 85.

Bearing in mind that over half of the major bleeds occurring in patients older than 75 involved the GIT, the authors recommended that routine prescription of a PPI for patients above the age of 75 could be considered for patients receiving antiplatelet therapy.

Read the full piece in The Lancet.