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HOMICIDES OF FRAIL OLDER PERSONS BY THEIR CAREGIVERS IN JAPAN

doses in the range of 81 to 325 mg/d for patients aged 60 to 74 in whom thromboembolic risk factors such as heart failure, left ventricular ejection fraction less than 35%, and history of hypertension had not been identified, and it also included men aged 75 and older as candidates for the use of aspirin as an alternative to warfarin. The rationale was that ‘‘patients with AF (atrial fibrillation) who have low rates of stroke when treated with aspirin may not gain sufficient benefit from anticoagulation to outweigh the attendant risks.’’ What that line of reasoning failed to acknowledge was that, without the benefit of aspirin versus placebo trials at those low doses, there was no means of identifying whether those ‘‘low rates of stroke when treated with aspirin’’ were attributable to a low thromboembolic risk profile per sec or to treatment with aspirin in doses less than 325 mg/d. That distinction is of more than academic interest, given the fact that low-dose aspirin has its own risk profile, exemplified by twice the risk of major bleeding as placebo and a 2.1% risk and 1.9% risk of major extracranial hemorrhage per year in men and women, respectively, allocated to 75 mg/d of aspirin in a study in which there was no placebo group with whom the hemorrhagic risk could be compared.