Aspirin Has a Protective Effect Against Adverse Outcomes in Patients with Nonvariceal Upper Gastrointestinal Bleeding

Wehbeh, Antonios; Tamim, Hani; Daya, Hussein Abu; Mrad, Rachel Abou; Badreddine, Rami J.; Eloubeidi, Mohamad A.; Rockey, Don C.; Barada, Kassem

doi:10.1007/s10620-015-3604-1

Cited by 19 publications

(22 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The use of aspirin or non-aspirin antiplatelet medication in patients presenting with upper GIB is reported to be associated with improved outcomes such as mortality and rebleeding in prospective 15 and retrospective studies. 18 One may speculate that such benefits with antiplatelet agents could be reduced with the rapid infusion of functional platelets. In addition to their effect on thrombosis, platelet transfusions are reported to be proinflammatory and alter recipient immunity.…”

Section: Discussionmentioning

confidence: 99%

No Benefit From Platelet Transfusion for Gastrointestinal Bleeding in Patients Taking Antiplatelet Agents

Zakko

Rustagi

Douglas

et al. 2017

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

No Benefit From Platelet Transfusion for Gastrointestinal Bleeding in Patients Taking Antiplatelet Agents

Zakko

Rustagi

Douglas

et al. 2017

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

“…The increased use of these ‘high-risk drugs’ causes more severe bleeding but has had no influence on the risk of fatal outcome.’[49] Finally, Wehbeh et al gave their report the title: ‘Aspirin has a protective effect against adverse outcomes in patients with non-variceal upper gastrointestinal bleeding’. [50]…”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Randomised Trials to Ascertain Fatal Gastrointestinal Bleeding Events Attributable to Preventive Low-Dose Aspirin: No Evidence of Increased Risk

et al. 2016

View full text Add to dashboard Cite

BackgroundAspirin has been shown to lower the incidence and the mortality of vascular disease and cancer but its wider adoption appears to be seriously impeded by concerns about gastrointestinal (GI) bleeding. Unlike heart attacks, stroke and cancer, GI bleeding is an acute event, usually followed by complete recovery. We propose therefore that a more appropriate evaluation of the risk-benefit balance would be based on fatal adverse events, rather than on the incidence of bleeding. We therefore present a literature search and meta-analysis to ascertain fatal events attributable to low-dose aspirin.MethodsIn a systematic literature review we identified reports of randomised controlled trials of aspirin in which both total GI bleeding events and bleeds that led to death had been reported. Principal investigators of studies in which fatal events had not been adequately described were contacted via email and asked for further details. A meta-analyses was then performed to estimate the risk of fatal gastrointestinal bleeding attributable to low-dose aspirin.ResultsEleven randomised trials were identified in the literature search. In these the relative risk (RR) of ‘major’ incident GI bleeding in subjects who had been randomised to low-dose aspirin was 1.55 (95% CI 1.33, 1.83), and the risk of a bleed attributable to aspirin being fatal was 0.45 (95% CI 0.25, 0.80). In all the subjects randomised to aspirin, compared with those randomised not to receive aspirin, there was no significant increase in the risk of a fatal bleed (RR 0.77; 95% CI 0.41, 1.43).ConclusionsThe majority of the adverse events caused by aspirin are GI bleeds, and there appears to be no valid evidence that the overall frequency of fatal GI bleeds is increased by aspirin. The substantive risk for prophylactic aspirin is therefore cerebral haemorrhage which can be fatal or severely disabling, with an estimated risk of one death and one disabling stroke for every 1,000 people taking aspirin for ten years. These adverse effects of aspirin should be weighed against the reductions in vascular disease and cancer.

show abstract

“…A total of 717 patients admitted for non-variceal upper gastrointestinal bleeding from 1993 to 2010 were studied 45. The primary outcome was in-hospital mortality.…”

Section: Resultsmentioning

confidence: 99%

Systematic Review of β Blocker, Aspirin, and Statin in Critically Ill Patients: Importance of Severity of Illness and Cardiac Troponin

Rothenberg

Clay²,

Jamali

et al. 2017

Journal of Investigative Medicine

View full text Add to dashboard Cite

Non-cardiac critically ill patients with type II myocardial infarction (MI) have a high risk of mortality. There are no evidence-based interventions to mitigate this risk. We systematically reviewed the literature regarding the use of medications known to reduce mortality in patients with cardiac troponin (cTn) elevation due to type I MI (β blockers, statin, and aspirin) in studies of critically ill patients without Type I MI. All PubMed publications between 1976-2/19/16 were reviewed. Search terms included: β blocker or aspirin or statin and intensive care unit (ICU) or critically ill or sepsis; 497 primary references were obtained. Inclusion criteria were as follows: (1) study population consisted of critically ill patients in the ICU with non-cardiovascular illnesses, (2) mortality end point, (3) severity of illness (or injury) was measured, and (4) the antiplatelet agent was primarily aspirin. Retrospective investigations, prospective observational studies, meta-analysis, systematic review, and randomized controlled trials were included; case reports were excluded. 25 primary references were obtained. The data were extracted and tabulated using data collection headings as follows: article title, first author/year/reference number, study type/design, population studied, outcome and intervention, and study question addressed. Evidence was not graded as the majority of studies were non-randomized (low-to-moderate quality). 11 studies were found through bibliography reviews for a total of 36 references. In conclusion, β blockers, statins, and aspirin may play a role in reducing mortality in non-cardiac critically ill patients. Benefit appears to be related to severity of illness, for which cTn may be a marker.

show abstract

Aspirin Has a Protective Effect Against Adverse Outcomes in Patients with Nonvariceal Upper Gastrointestinal Bleeding

Abstract: Patients who present with NVUGIB on aspirin had reduced in-hospital mortality and fewer adverse outcomes, while those on anticoagulants had increased in-hospital complications.

Cited by 19 publications

References 38 publications

No Benefit From Platelet Transfusion for Gastrointestinal Bleeding in Patients Taking Antiplatelet Agents

No Benefit From Platelet Transfusion for Gastrointestinal Bleeding in Patients Taking Antiplatelet Agents

Systematic Review and Meta-Analysis of Randomised Trials to Ascertain Fatal Gastrointestinal Bleeding Events Attributable to Preventive Low-Dose Aspirin: No Evidence of Increased Risk

Systematic Review of β Blocker, Aspirin, and Statin in Critically Ill Patients: Importance of Severity of Illness and Cardiac Troponin

Contact Info

Product

Resources

About