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[Should coronary patients chronically taking a low-dose of aspirin receive gastroprotective agents?]
1Servicio de Aparato Digestivo, Hospital Clínico Universitario, Zaragoza. alanas@doymanet.es
Insights
Low-dose aspirin increases gastrointestinal bleeding risk, though less than NSAIDs. Proton pump inhibitors with H. pylori eradication offer the best protection for high-risk patients.
Area of Science:
- Gastroenterology
- Pharmacology
- Internal Medicine
Context:
- Low-dose aspirin (75-300 mg/day) is widely used but carries a risk of gastrointestinal (GI) bleeding.
- This risk is lower compared to nonsteroidal anti-inflammatory drugs (NSAIDs).
- Identifying risk factors for GI bleeding in aspirin users is crucial for preventative strategies.
Purpose:
- To review the risk factors for gastrointestinal bleeding associated with low-dose aspirin use.
- To evaluate the efficacy of gastroprotective agents in preventing aspirin-induced GI bleeding.
- To discuss the optimal management strategies for patients at risk.
Summary:
- Low-dose aspirin use is linked to increased GI bleeding risk, albeit lower than with NSAIDs.
- Patients with a history of peptic ulcers, concurrent NSAID use, or serious illnesses require gastroprotection.
- Proton pump inhibitors, especially when combined with Helicobacter pylori eradication, demonstrate the highest efficacy in preventing GI bleeding.
Impact:
- Informs clinical practice regarding the management of low-dose aspirin users at risk of GI bleeding.
- Highlights the importance of gastroprotection for specific patient populations.
- Suggests proton pump inhibitors as a primary therapeutic option for GI bleeding prevention in this cohort.
Abstract:
The use of low-dose aspirin (75-300 mg/day) is associated with an increased risk of gastrointestinal bleeding, which is lower than that observed with common NSAIDs. Risk factors for the development of GI bleeding in patients taking low-dose aspirin are not well defined, although patients with a previous history of peptic ulcer, concomitant NSAID use and serious diseases should receive gastroprotection. Among the available drugs, proton pump inhibitors associated, when present, to Helicobacter pylori erradication, have shown the highest efficacy. The best cost-effectiveness treatment is still undefined.