Could Aspirin Avert Bad Outcomes in Leukemia?

HOUSTON — A new analysis hints that there may be a benefit from aspirin for hospitalized patients with leukemia. In a preliminary study, researchers found that aspirin users had much lower odds of intracranial bleeding, deep vein thrombosis, in-hospital mortality, and septic stroke.

Aspirin users also spent less time in the hospital and had less costly care.

No one is suggesting that clinicians give aspirin to hospitalized patients with leukemia when the drug is not otherwise indicated. However, the findings, released at the Society of Hematologic Oncology (SOHO) 2024 in Houston, do indicate that more research is warranted, said study lead author Jayalekshmi Jayakumar, MD, of The Brooklyn Hospital Center in New York City, in a presentation.

“We hope our study can act as background for further prospective and experimental studies to explore this association,” she said. “If we can establish causation, then aspirin has a potential to be a thromboprophylactic agent to enhance outcomes and reduce resource utilization among leukemia hospitalizations.”

Jayakumar noted that previous research has suggested aspirin may help prevent deep vein thrombosis in patients with breast and pancreatic cancer. And in blood cancer, animal research has suggested that aspirin may “promote apoptosis in leukemia cells and decrease the spread of leukemia cells through platelet inhibition,” she said. 

However, “we do not have any prospective or retrospective studies to establish causation or to see if this actually has some value within the clinical practice,” she noted.

Jayakumar stated that new study aims to detect whether aspirin may be beneficial in leukemia. She and her colleagues retrospectively tracked 1,663,149 US hospitalizations of patients with leukemia from 2016 to 2020 via the National Inpatient Sample. Of those patients, 11.2% used aspirin, although the data didn’t say whether they started it during hospitalization, and dosages were not reported. Aspirin users were older (mean age, 74.53 years vs 64.83 years in nonusers).

After adjustment for confounders, aspirin users had lower odds of several conditions than nonusers:

• Epistaxis (odds ratio [OR], 0.63; 95% CI, 0.55-0.72; P < .001)
• Hemoptysis (OR, 0.71; 95% CI, 0.61-0.82; P < .001)
• Intracranial bleed (OR, 0.74; 95% CI, 0.64-0.85; P < .001)
• Deep vein thrombosis (OR, 0.72; 95% CI, 0.66-0.78; P < .001) 
• In-hospital mortality (OR, 0.54; 95% CI, 0.50-0.58; P < .001)
• Sepsis (OR, 0.71; 95% CI, 0.68-0.75; P < .001)
• Septic shock (OR, 0.55; 95% CI, 0.50-0.60; P < .001)

There was no association reported for gastrointestinal bleeding, a possible side effect of aspirin use, or tumor lysis syndrome. Aspirin users also had a shorter typical stay (−2.8 days) and lower typical hospital charges ($40,719).

“We also found that aspirin users had a slightly reduced risk of minor bleeding and infection compared to nonaspirin users,” Jayakumar said.

In an interview, Jayakumar noted that the study is retrospective and declined to speculate on why aspirin may have benefits or why it may have the seemingly contradictory effect of reducing both blood clots and bleeding.

Aspirin is one of the least expensive drugs in existence. 

In an interview, Richard M. Stone, MD, oncologist at Dana-Farber Cancer Institute in Boston, who’s familiar with the study findings but didn’t take part in the research, said the findings are “totally counterintuitive.”

“It doesn’t mean they should be rejected, but they should be highly scrutinized,” he said. 

Stone added that bleeding is a major risk in leukemia due to low platelet counts, although platelet transplants can be helpful, and patients rarely die of bleeding. Thrombosis is also a problem in leukemia, he said, and it’s being increasingly recognized as a risk in acute myeloid leukemia.

No funding was reported. Jayakumar and Stone had no disclosures.

Randy Dotinga is an independent writer and a board member of the Association of Health Care Journalists.