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Epidemiology of Upper Gastrointestinal Damage Associated with Low-Dose Aspirin
1Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, 386 Ta Chung 1st Road, Kaohsiung 813, Taiwan. tjtsai@vghks.gov.tw.
Insights
Low-dose aspirin effectively protects against cardiovascular events but carries risks of upper gastrointestinal issues. Managing gastrointestinal risk factors is crucial for patients on aspirin therapy.
Area of Science:
- Cardiology
- Gastroenterology
- Pharmacology
Background:
- Low-dose aspirin (75-325 mg daily) is a cornerstone for cardiovascular (CV) protection, offering cost-effectiveness and sustained antiplatelet action.
- Despite its benefits, aspirin therapy is linked to significant upper gastrointestinal (GI) adverse effects, including dyspepsia, erosions, and peptic ulcers.
- Risk factors for aspirin-induced GI complications include a history of ulcers, older age, H. pylori infection, and concurrent use of NSAIDs, other antiplatelets, or anticoagulants.
Purpose of the Study:
- To summarize the benefits and risks of low-dose aspirin for cardiovascular protection.
- To identify key risk factors associated with aspirin-induced upper GI complications.
- To outline strategies for preventing and managing GI side effects in patients on long-term aspirin therapy.
Main Methods:
- Review of existing literature on low-dose aspirin's efficacy and safety profile.
- Analysis of reported incidences and risk factors for upper GI complications associated with aspirin use.
- Evaluation of preventive strategies, including risk assessment and pharmacotherapy.
Main Results:
- Low-dose aspirin significantly reduces CV events but has a notable prevalence of GI side effects, such as dyspepsia (31%) and gastroduodenal erosions (60%).
- The incidence of peptic ulcers and GI bleeding is substantial, with specific patient groups facing higher risks.
- Enteric-coated or buffered aspirin formulations do not mitigate the risk of upper GI complications.
Conclusions:
- Patient assessment for gastrointestinal risk is essential before initiating or continuing antiplatelet therapy.
- High-GI-risk patients should receive co-therapy with antisecretory agents, particularly proton pump inhibitors, to prevent ulcers.
- H. pylori eradication is recommended for patients with a history of peptic ulcer or GI bleeding requiring long-term aspirin therapy.
Abstract:
Low-dose aspirin, commonly defined as 75-325 mg daily, is widely used for cardiovascular (CV) protection. It reduced the risk of CV events and death in patients with coronary and cerebrovascular diseases and has the advantages of both low cost and long duration of antiplatelet action. However, low-dose aspirin therapy is associated with upper gastrointestinal (GI) side effects, which range from dyspepsia (point prevalence: 31%), gastroduodenal erosions (point prevalence: 60%), endoscopic peptic ulcer (3-month incidence: 7%) to symptomatic or complicated ulcers (annual incidence of upper GI bleeding: 0.6%; relative risk of upper GI bleeding: 2.6). The important factors that increase the risk of low-dose aspirin-related ulcer complications include a history of bleeding peptic ulcer, prior peptic ulcer, age > 70 years, H pylori infection, and concomitant drug therapy with non-steroidal anti-inflammatory drugs, other antiplatelet agents (e.g., clopidogrel) or anticoagulants. The use of enteric-coated or buffered preparations do not reduce the risk of upper GI complications. Assessment of GI risk for patients is a crucial step in preventing complications of antiplatelet agents. Patients with a high GI risk should prevent peptic ulcer or ulcer complications by co-therapy with an antisecretory agent, especially proton pump inhibitors. H pylori eradication is recommended for patients requiring long-term low-dose aspirin therapy who have a prior history of peptic ulcer or GI bleeding.
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