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The risk of lower gastrointestinal bleeding in low-dose aspirin users
W-C Chen1,2, K-H Lin1, Y-T Huang3
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Insights
Low-dose aspirin significantly increases the risk of lower gastrointestinal bleeding (LGIB). Other medications like NSAIDs, steroids, SSRIs, PPIs, and H2RAs also independently elevate LGIB risk.
Area of Science:
- Gastroenterology
- Pharmacology
- Epidemiology
Background:
- Aspirin is widely used for cardiovascular prevention.
- Gastrointestinal bleeding is a known complication of aspirin use.
- The specific risk of lower gastrointestinal bleeding (LGIB) in low-dose aspirin users requires further investigation.
Purpose of the Study:
- To investigate the association between low-dose aspirin use and the risk of lower gastrointestinal bleeding (LGIB).
- To identify independent risk factors for LGIB in a large-scale population cohort.
Main Methods:
- A nationwide cohort study was conducted using Taiwan's National Health Insurance Research Database.
- Low-dose aspirin users (75-325 mg daily) were matched 1:5 with aspirin nonusers based on age, gender, and enrollment time.
- Cox proportional hazard regression models were used to assess LGIB predictors, adjusting for various comorbidities and concomitant medications.
Main Results:
- The study included 53,805 aspirin users and 269,025 controls.
- Aspirin users exhibited a higher incidence of LGIB within one year compared to controls (0.20% vs. 0.06%, P<.0001).
- Aspirin (HR: 2.75), NSAIDs (HR: 8.61), steroids (HR: 10.50), SSRIs (HR: 11.71), PPIs (HR: 8.47), and H2RAs (HR: 10.83) were significantly associated with increased LGIB risk.
Conclusions:
- Low-dose aspirin use is associated with an elevated risk of lower gastrointestinal bleeding.
- Concomitant use of NSAIDs, steroids, SSRIs, PPIs, and H2RAs are independent risk factors for LGIB.
- These findings highlight the importance of considering medication interactions and patient comorbidities when prescribing aspirin.
Background:
Aspirin increases the risk of gastrointestinal bleeding.
Aim:
To investigate the risk of lower gastrointestinal bleeding (LGIB) in aspirin users.
Methods:
Low-dose (75-325 mg daily) aspirin users and controls matched by age, gender and enrollment time in a 1:5 ratio were selected from 1 million randomly sampled subjects in the National Health Insurance Research Database of Taiwan. Cox proportional hazard regression models were developed to evaluate the predictors of LGIB with adjustments for age, gender, comorbidities including coronary artery disease, ischaemic stroke, diabetes, hypertension, chronic kidney disease, liver cirrhosis, chronic obstructive pulmonary disease, dyslipidemia, uncomplicated peptic ulcer disease, history of peptic ulcer bleeding, and concomitant use of clopidogrel, ticlopidine, warfarin, nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 inhibitors, steroids, proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), nitrates, alendronate, selective serotonin reuptake inhibitors (SSRIs) and calcium channel blockers.
Results:
A total of 53 805 aspirin users and 269 025 controls were included. Aspirin group had a higher incidence of LGIB within 1 year than control group (0.20% vs 0.06%, P<.0001). Aspirin (hazard ratio [HR]: 2.75, 95% confidence interval [CI]: 2.06-3.65), NSAIDs (HR: 8.61, 95% CI: 3.28-22.58), steroids (HR: 10.50, 95% CI: 1.98-55.57), SSRIs (HR: 11.71, 95% CI: 1.40-97.94), PPIs (HR: 8.47, 95% CI: 2.26-31.71), and H2RAs (HR: 10.83, 95% CI: 2.98-39.33) were significantly associated with LGIB.
Conclusions:
The risk of LGIB was higher in low-dose aspirin users than in aspirin nonusers in this nationwide cohort. Low-dose aspirin, NSAIDs, steroids, SSRIs, PPIs and H2RAs were independent risk factors for LGIB.
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