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Review article: aspirin and gastrointestinal bleeding
1Department of Therapeutics, University Hospital, Nottingham, UK.
Alimentary Pharmacology & Therapeutics
|April 1, 1994
Summary
Aspirin use can lead to gastric bleeding and ulcers due to its ulcerogenic and anti-hemostatic effects. While increasing upper gastrointestinal bleeding risk, aspirin is not linked to increased mortality from these complications.
Area of Science:
- Gastroenterology
- Pharmacology
- Hematology
Background:
- Aspirin is widely used for cardiovascular prophylaxis and pain relief.
- Studies indicate aspirin causes gastric erosions and microbleeding.
- Chronic aspirin use is linked to gastric ulcers and gastrointestinal bleeding events.
Purpose of the Study:
- To investigate the dual role of aspirin in causing upper gastrointestinal bleeding.
- To differentiate between aspirin's ulcerogenic and anti-hemostatic contributions to bleeding.
- To assess the overall risk and mortality associated with aspirin-induced gastrointestinal complications.
Main Methods:
- Review of animal and human studies on aspirin's effects on gastric mucosa.
- Analysis of data on aspirin's association with gastric and duodenal ulcers.
- Evaluation of aspirin's impact on bleeding times and hemostasis.
- Comparison of bleeding risks between aspirin and non-aspirin NSAIDs.
Main Results:
- Aspirin causes gastric mucosal injury and enhances microbleeding.
- Chronic use is associated with gastric ulcers and bleeding presentations (hematemesis, melaena).
- Both ulcerogenic and anti-hemostatic effects contribute to aspirin-related bleeding.
- Aspirin enhances bleeding from mucosal injury, similar to its effect on skin bleeding time.
- Low-dose aspirin for prophylaxis may increase bleeding presentation risk.
- Aspirin 300 mg causes significant mucosal injury, less than 600 mg q.d.s.
- Estimated 700 aspirin-related bleeds annually in the UK.
- Relative risk of upper GI bleeding is similar to non-aspirin NSAIDs.
- Aspirin users experiencing bleeding are generally younger with lower mortality risk.
Conclusions:
- Aspirin possesses both ulcerogenic and anti-hemostatic properties contributing to upper gastrointestinal bleeding.
- The risk of aspirin-induced bleeding, while present, must be considered in context.
- Aspirin use is not associated with increased mortality from upper gastrointestinal complications, unlike other NSAIDs.