Gastrointestinal safety of low-dose aspirin

The cardioprotective benefits of aspirin support the use of low-dose regimens for primary and secondary prevention of cardiovascular disease. However, these cardioprotective benefits must often be balanced against the well-documented gastrointestinal (GI) effects of aspirin. Recent research suggests that the GI effects of aspirin may be dose-dependent; however, even low-dose aspirin can cause significant GI sequelae. Similarly, the use of nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs), including cyclooxygenase (COX)-2 inhibitors, has also been shown to increase the risk of GI effects, and the concomitant use of aspirin and nonaspirin NSAIDs can significantly increase the risk of GI ulceration and bleeding. Therefore, clinicians should use the lowest effective dose of aspirin (ie, 75 to 150 mg/day) that affords cardiovascular benefits without increasing the risk of GI effects. Low-dose aspirin therapy can complicate the concurrent use of analgesics. When an analgesic is needed in addition to aspirin, concomitant use of aspirin and nonaspirin NSAIDs or COX-2 inhibitors should be used with caution, or with concomitant gastroprotective agents, to minimize the risk of GI complications. In contrast, because acetaminophen does not cause GI irritation, it should therefore be considered when an analgesic is needed.