Patterns of Inappropriate Aspirin Use Among Older Adults Presenting to the Emergency Department With Bleeding

Inappropriate aspirin use can lead to preventable emergency department (ED) visits for bleeding, yet its prevalence among older adults presenting with such events remains unclear. This study examines patterns of likely inappropriate aspirin use and explores patient-level factors associated with high-risk use among older adults presenting to the ED with bleeding.

We conducted a cross-sectional analysis nested within an ongoing prospective cohort study of older adults (≥65 years old) presenting with bleeding while on aspirin at six emergency departments. Patients were identified using a structured algorithm based on chief complaints and diagnostic codes. Patients were enrolled post-visit and data collected via chart review and participant interviews at 14 and 30 days. Aspirin appropriateness was assessed using a modified Medication Appropriateness Index [MAI] examining four domains: (1) lack of clear indication, (2) excessive dose (> 81 mg daily), (3) clinically relevant drug-drug interactions, and (4) clinically relevant drug-disease interactions. MAI scores were categorized as appropriate (0), potentially inappropriate (1–2), or likely inappropriate (≥3). We examined unadjusted associations between patient demographics (age, sex, race, ethnicity, education level, and self-prescription of aspirin) and high-risk aspirin use (MAI > 0). Continuous variables were analyzed using t-tests, and categorical variables using chi-squared tests.

To date, we have enrolled 142 older adults presenting with bleeding while on aspirin. Participants had a mean age of 76 years (SD 6) with an even divide on sex (50% female), and were predominantly white (77%) and non-Hispanic (95%). Potentially inappropriate aspirin use was observed in 32% of subjects (95% CI: 25-40%), with likely inappropriate use observed in 44% of subjects (95% CI: 36-52%). Appropriate aspirin use was observed among 25% of subjects (95% CI: 18-32%). In the unadjusted bivariate analyses, only self-prescription of aspirin was found to be associated with high-risk aspirin use (p=0.048).

Potentially inappropriate aspirin use is common among older adults presenting to the ED with bleeding, particularly among those who self-prescribe. These patients should be prioritized for deprescribing interventions to reduce inappropriate use and prevent recurrent bleeding episodes.