Aspirin and Proton Pump Inhibitor Combination Therapy for Prevention of Cardiovascular Disease and Barrett's Esophagus

Abstract

Aspirin, used at low doses (75-325 mg daily), prevents aggregation of platelets and is prescribed for patients as pharmacologic prevention of cardiovascular disease. Despite the well-documented beneficial effects of aspirin, prolonged use is associated with damage to the gastrointestinal (GI) mucosa in the upper and lower GI tract. Patient risk of hemorrhage and peptic ulcer formation is increased with older age, previous ulcer history, Helicobacter pylori infection, and concomitant use of nonsteroidal anti-inflammatory drugs, corticosteroids, or antithrombotic agents. As termination of aspirin therapy can precipitate a cardiovascular event, patients at risk need co-therapy with gastroprotective agents, such as proton pump inhibitors (PPIs), to reduce the GI side effects of aspirin treatment. Fixed-dose combinations of low-dose aspirin and gastroprotective agents have been designed to increase medication compliance, improve clinical outcomes, and reduce the overall cost of therapy. Prolonged use of PPIs may, however, lead to serious adverse effects or, in some cases, reduce the cardioprotective effects of aspirin. Hence, physicians need to carefully consider the benefits and risks associated with the condition of each patient to optimize clinical outcomes of combination therapy. A growing body of clinical evidence indicates that aspirin may decrease the risk of colorectal and other GI cancers, as well as reduce progression from Barrett's esophagus (BE) to esophageal adenocarcinoma. Furthermore, PPIs have recently been shown to reduce neoplastic transformation in patients with BE. Thus, the use of a fixed-dose aspirin/PPI combination could potentially provide chemopreventive benefit to patients with BE, and, at the same time, treat the underlying gastroesophageal reflux responsible for the condition.

Gastric Cancer in Iran: An Overview of Risk Factors and Preventive Measures

“…124 We should be aware that prolonged aspirin use alone might damage the gastric mucosa, but its combination with proton pump inhibitors could potentially reduce injuries. 125 Statins are another category of this sort that reduce the incidence of GC by inhibiting HP CagA. 126 Although the literature has inconsistent evidence on the chemoprophylactic effect of statins on GC, 127 a recent meta-analysis supports this hypothesis.…”

Dilema Penggunaan Aspirin dan Proton Pump Inhibitor (PPI) Pada Pasien Gastroesophageal Reflux Disease Dengan Coronary Artery Disease (CAD)

“…17,22 Pada pasien yang mengkonsumsi aspirin penggunaan H2RAs dapat menekan produksi asam lambung sebesar 37% sampai 68% selama 24 jam dan memiliki perlindungan yang lebih baik pada kasus pendarahan pada gastrointestinal. 23 Resiko pendarahan pada gastrointestinal meningkat dua kali lipat dengan penggunaan aspirin dosis rendah, dan resiko ini akan berlipat ganda dengan dikonsumsi clopidogrel sebagai DAPT. 24 Perdarahan gastrointestinal mengancam nyawa, terutama pada pasien dengan sindrom koroner akut.…”

Large Bowel Genetic Background and Inflammatory Processes in Carcinogenesis – Systematic Review

“…High doses of aspirin (> 325 mg per day) have analgesic and strong anti-inflammatory effects. Ultimately, individual assessment of the benefits and risks of using NSAIDs is the key to effective treatment [33,[36][37][38].…”