Prognostic bleeding risk models that can estimate the absolute bleeding harms of aspirin have been developed for individuals in whom aspirin is being considered for primary prevention of cardiovascular disease (CVD), according to a study published online Feb. 26 in the Annals of Internal Medicine.

Vanessa Selak, M.B.Ch.B., Ph.D., from the University of Auckland in New Zealand, and colleagues conducted a prospective cohort study involving 385,191 persons aged 30 to 79 years whose CVD risk was assessed. Prognostic bleeding risk models were developed among persons in whom aspirin might be considered for the primary prevention of CVD. The main models included demographic characteristics, clinical measurements, family history of premature CVD, medical history, and medication use.

The researchers found that 4,442 persons had major bleeding events during 1,619,846 person-years of follow-up; 7 percent of these events were fatal. The main models predicted a median five-year bleeding risk of 1.0 and 1.1 percent in women and men, respectively. There was good calibration throughout the risk range in plots of predicted-against-observed event rates.

"The question of in whom the benefits of using aspirin for primary prevention are likely to outweigh its harms could be addressed by an individualized estimate of the numbers of CVD events likely to be avoided with, and bleeding events caused by, aspirin," the authors write. "Such a tool, using the prognostic bleeding risk models described in this article, is under development."

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