Aspirin is the most widely used drug in the world, in large part thanks to its popularity as a daily prophylactic against dangerous cardiac events in older adults.

Though there’s longstanding evidence that taking low-dose aspirin every day can help prevent events like heart attack and stroke, more recent research has made it clear that certain risks associated with this regimen may outweigh the benefits. One, in particular, is the risk of serious internal bleeding, which can be devastating for older people.

A new study has found for the first time that daily aspirin also increases the risk of more minor bleeding, which over time can cause anemia. Though the mechanisms are unclear, researchers suspect it has something to do with aspirin’s interference in blood clotting.

Data from the international Aspirin in Reducing Events in the Elderly (ASPREE) study show that people over age 65 who took daily low-dose aspirin were 20% more likely to be anemic than those who didn’t. As we continue to learn more about the risks of a daily aspirin routine, it’s a good reminder to always check with your doctor before adding a new medication to your pillbox—even if it’s over-the-counter.

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