In older adults, which practice about aspirin for primary prevention is inappropriate?

• A. Initiate a high-intensity statin for primary prevention
• B. Start aspirin for primary prevention
• C. Start warfarin for primary prevention
• D. Start ACE inhibitor for prevention of cardiovascular disease

Answer: (B)

Starting aspirin for primary prevention in older adults is inappropriate. In this age group, the potential harms from aspirin, chiefly major bleeding such as gastrointestinal bleeding or intracranial hemorrhage, tend to outweigh any modest cardiovascular benefits. The Beers Criteria and contemporary guidance for older adults emphasize avoiding routine aspirin initiation for primary prevention in those over 70, because the net benefit is not favorable. When younger seniors (60–69) have high cardiovascular risk and low bleeding risk, a discussion about aspirin may occur, but in most older patients the balance favors not starting it.