Clinical trial: the incidence and early mortality after peptic ulcer perforation, and the use of low‐dose aspirin and nonsteroidal anti‐inflammatory drugs

Taha, A S; Angerson, Wilson J.; Prasad, Rajendra; McCloskey, Caroline; Gilmour, Danielle; Morran, C. G.

doi:10.1111/j.1365-2036.2008.03808.x

Cited by 32 publications

(24 citation statements)

References 25 publications

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“…The annual estimated incidence of perforation in patients older than 65 years is 32.7 per 100,000 patient-years. More than a third of them are associated with LDA users [21,22].…”

Section: Effects Of Low-dose Aspirin In the Gastrointestinal Tractmentioning

confidence: 99%

Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

Lanas

Gargallo²

2015

J Gastroenterol

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Low-dose aspirin, alone or combined with other antiplatelet agents, is increasingly prescribed for cardiovascular prevention. However, the cardiovascular benefits should be evaluated together with the gastrointestinal risks. Low-dose aspirin is associated with upper and lower gastrointestinal injury, although lower gastrointestinal effects are poorly characterized. This gastrointestinal risk differs among antiplatelets drugs users. The most important risk factors are history of peptic ulcer, older age, and concomitant use of non-steroidal anti-inflammatory drugs or dual antiplatelet therapy. Effective upper gastrointestinal prevention strategies are available and should be used in at-risk patients taking low-dose aspirin or clopidogrel. Proton pump inhibitors seem to be the best gastroprotective agents, whereas the benefits of Helicobacter pylori eradication are still unclear. Low-dose aspirin has additional effects in the gastrointestinal tract. A large body of evidence indicates that it can protect against different cancers, in particular colorectal cancer. This effect could modify the future indications for use of low-dose aspirin and the risk-benefit balance.

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“…The annual estimated incidence of perforation in patients older than 65 years is 32.7 per 100,000 patient-years. More than a third of them are associated with LDA users [21,22].…”

Section: Effects Of Low-dose Aspirin In the Gastrointestinal Tractmentioning

confidence: 99%

Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

Lanas

Gargallo²

2015

J Gastroenterol

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“…[9] Such adverse events may compromise adherence to low-dose ASA therapy, [10] placing patients at an increased risk of serious vascular events. [5,11] However, the link between adverse GI events and nonadherence to, and discontinuation of, low-dose ASA therapy is not well established in the literature.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Upper Gastrointestinal Symptoms on Nonadherence to, and Discontinuation of, Low-Dose Acetylsalicylic Acid in Patients with Cardiovascular Risk

Pratt

Thompson

Elkin

et al. 2010

American Journal Cardiovascular Drugs

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“…Low-dose ASA-associated adverse gastrointestinal effects range from troublesome upper gastrointestinal problems such as dyspeptic symptoms and heartburn6 7 to serious peptic ulcer complications, including gastrointestinal bleeding6 8 and perforated ulcers 9. Peptic ulcer complications have been reported to occur more than twice as frequently among low-dose ASA users than controls,10 11 even among patients taking low-dose ASA for >3 months 12.…”

Section: Introductionmentioning

confidence: 99%

Prevention of peptic ulcers with esomeprazole in patients at risk of ulcer development treated with low-dose acetylsalicylic acid: a randomised, controlled trial (OBERON)

Scheiman

Devereaux

Herlitz

et al. 2011

Heart

125

114

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ObjectiveTo determine whether once-daily esomeprazole 40 mg or 20 mg compared with placebo reduces the incidence of peptic ulcers over 26 weeks of treatment in patients taking low-dose acetylsalicylic acid (ASA) and who are at risk for ulcer development.DesignMultinational, randomised, blinded, parallel-group, placebo-controlled trial.SettingCardiology, primary care and gastroenterology centres (n=240).PatientsHelicobacter pylori-negative patients taking daily low-dose ASA (75–325 mg), who fulfilled one or more of the following criteria: age ≥18 years with history of uncomplicated peptic ulcer; age ≥60 years with either stable coronary artery disease, upper gastrointestinal symptoms and five or more gastric/duodenal erosions, or low-dose ASA treatment initiated within 1 month of randomisation; or age ≥65 years. All patients were ulcer-free at study entry.InterventionsOnce-daily, blinded treatment with esomeprazole 40 mg, 20 mg or placebo for 26 weeks.Main outcome measuresThe primary end point was the occurrence of endoscopy-confirmed peptic ulcer over 26 weeks.ResultsA total of 2426 patients (52% men; mean age 68 years) were randomised. After 26 weeks, esomeprazole 40 mg and 20 mg significantly reduced the cumulative proportion of patients developing peptic ulcers; 1.5% of esomeprazole 40 mg and 1.1% of esomeprazole 20 mg recipients, compared with 7.4% of placebo recipients, developed peptic ulcers (both p<0.0001 vs placebo). Esomeprazole was generally well tolerated.ConclusionsAcid-suppressive treatment with once-daily esomeprazole 40 mg or 20 mg reduces the occurrence of peptic ulcers in patients at risk for ulcer development who are taking low-dose ASA.Clinical trial registration numberClinicalTrials.gov identifier: NCT00441727.

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Clinical trial: the incidence and early mortality after peptic ulcer perforation, and the use of low‐dose aspirin and nonsteroidal anti‐inflammatory drugs

Abstract: SUMMARY BackgroundIt is not clear whether the incidence or early mortality related to peptic ulcer perforation has changed.

Cited by 32 publications

References 25 publications

Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

The Impact of Upper Gastrointestinal Symptoms on Nonadherence to, and Discontinuation of, Low-Dose Acetylsalicylic Acid in Patients with Cardiovascular Risk

Prevention of peptic ulcers with esomeprazole in patients at risk of ulcer development treated with low-dose acetylsalicylic acid: a randomised, controlled trial (OBERON)

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