Risk of upper gastrointestinal bleeding associated with use of low-dose aspirin

Authors: Sorensen, H.T.1; Mellemkjaer, L.; Blot, W.J.; Nielsen, G.L.; Steffensen, F.H.; McLaughlin, J.K.; Olsen, J.H.

Source: The American Journal of Gastroenterology, Volume 95, Number 9, 1 September 2000 , pp. 2218-2224(7)

Publisher: Blackwell Publishing

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Abstract:

OBJECTIVE:Aspirin products are known to cause irritation and injury to the gastric mucosa. We examined the risk of hospitalization for upper gastrointestinal bleeding with use of low-dose aspirin.METHODS:This was a cohort study based on record linkage between a population-based prescription database and a hospital discharge registry in North Jutland County, Denmark, from January 1, 1991, to December 31, 1995. Incidence rates of upper gastrointestinal bleeding in 27,694 users of low-dose aspirin were compared with the incidence rates in the general population in the county.RESULTS:A total of 207 exclusive users of low-dose aspirin experienced a first episode of upper gastrointestinal bleeding with admission to the hospital during the study period. The standardized incidence rate ratio was 2.6 (95% confidence interval, 2.2-2.9), 2.3 in women and 2.8 in men. The standardized incidence rate ratio for combined use of low-dose aspirin and other nonsteroidal anti-inflammatory drugs was 5.6 (95% confidence interval, 4.4-7.0). The risk was similar among users of noncoated low-dose aspirin (standardized incidence rate ratio, 2.6; 95% confidence interval, 1.8-3.5) and coated low-dose aspirin (standardized incidence rate ratio, 2.6; 95% confidence interval, 2.2-3.0).CONCLUSIONS:Use of low-dose aspirin was associated with an increased risk of upper gastrointestinal bleeding, with still higher risks when combined with other nonsteroidal anti-inflammatory drugs. Enteric coating did not seem to reduce the risk. The findings from this observational study raise the possibility that prophylactic use of low-dose aspirin may convey an increased risk of gastrointestinal bleeding, which may offset some of its benefits.

Document Type: Research article

DOI: 10.1016/S0002-9270(00)01040-6

Affiliations: 1: aDepartment of Clinical Epidemiology, Aarhus University and Aalborg Hospitals, , Aarhus, Denmark

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