The use of nitrovasodilator drugs is independently associated with a decreased risk of upper gastrointestinal bleeding.

SUMMARYBackground: Aspirin is valuable for preventing vascular events, but information about ulcer frequency is necessary to inform risk-benefit decisions in individual patients. Aim: To determine ulcer prevalence and incidence in a population representative of those given aspirin therapy and evaluate risk predictors. Methods: Patients taking aspirin 75-325 mg daily were recruited from four countries. Exclusions included use of gastroprotectant drugs or other non-steroidal antiinflammatory drugs. We measured point prevalence of endoscopic ulcers, after quantitating dyspeptic symptoms. Incidence was assessed 3 months later in those eligible to continue (no baseline ulcer or reason for gastroprotectants).

Late and sudden thrombosis after PTCA followed by intracoronary radiotherapy is a new phenomenon in interventional cardiology.

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SUMMARYBackground: Most patients with vascular-occlusive diseases benefit from low-dose aspirin (75-325 mg ⁄ day). However, they have an increased risk of upper gastrointestinal bleeding (UGIB). Aims: To analyse the incidence and factors influencing the occurrence of UGIB in patients taking low-dose aspirin for the prevention of cardiovascular diseases outside clinical trials. Methods: We studied 903 consecutive patients discharged on low-dose aspirin from the Cardiology Department of a general hospital. Data were collected from medical charts and structured telephone interviews.

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Aim: To evaluate the role of Helicobacter pylori infection and other clinical factors in the risk of upper gastrointestinal bleeding in patients taking low‐dose aspirin. Subjects and methods: A case–control study was carried out of consecutive current users of low‐dose aspirin admitted because of upper gastrointestinal bleeding. Within a cohort of 695 patients with upper gastrointestinal bleeding, 98 patients had taken low‐dose aspirin and no other non‐steroidal anti‐inflammatory drug. Controls were 147 low‐dose aspirin users without upper gastrointestinal bleeding of similar age, sex and extent of aspirin use as cases. H. pylori infection was determined by CagA/VacA serology and 13C‐urea breath test in all cases and controls. Adjusted odds ratios (OR) are provided. Results: H. pylori infection was identified as an independent risk factor of upper gastrointestinal bleeding in this population (OR, 4.7; 95% confidence interval (95% CI), 2.0–10.9), but the presence of CagA‐positive serology was not. Other risk factors identified were a previous ulcer history (OR, 15.2; 95% CI, 3.8–60.1), alcohol use (OR, 4.2; 95% CI, 1.7–10.4) and use of calcium channel blockers (OR, 2.54; 95% CI, 1.25–5.14). Antisecretory therapy (OR, 0.1; 95% CI, 0.02–0.3) and nitrovasodilators (OR, 0.2; 95% CI, 0.1–0.6) decreased the risk of bleeding. Conclusions: H. pylori infection is a risk factor for upper gastrointestinal bleeding in low‐dose aspirin users, which might have therapeutic implications in high‐risk patients.

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