Continuation of Low-Dose Aspirin Therapy in Peptic Ulcer Bleeding

Abstract

Among low-dose aspirin recipients who had peptic ulcer bleeding, continuous aspirin therapy may increase the risk for recurrent bleeding but potentially reduces mortality rates. Larger trials are needed to confirm these findings.

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

“…Comment: Long-term therapy with LDA is associated with a significant increase in the incidence and recurrence of gastrointestinal (GI) hemorrhage [119], whereas continuous LDA therapy reduces mortality rates related to cardiovascular (CV) events [15]. In the incidence of recurrent ulcer bleeding and peptic ulcer healing rates, there were no differences between the PPI and PPI-plus-LDA [120] CQ.…”

“…The high-risk conditions for thromboembolism associated with withdrawal of antithrombotic therapy were shown in the Table 3 of Guidelines of Japan Gastroenterological Endoscopy Society [Dig Endosc: 2014; 26:1-14 (a paper that was out of the searched period)]. Mortality was significantly lower in the group continuing anti-platelet agents compared with the group with withdrawing them among patients with hemorrhagic peptic ulcer with cardiovascular and/or cerebrovascular diseases [15]. On the other hand, we can suspend anti-platelet agents in patients with low-risk conditions for thromboembolism.…”

Epidemiology of Upper Gastrointestinal Bleeding

“…A recent trial has demonstrated that in the short term patients with known cardiovascular risk factors benefit from an early reintroduction of aspirin to reduce their cardiovascular death, and this supports the hypothesis that treating co-morbidity and accepting some rebleeding risk reduces excess death following a bleed, albeit in a restricted subgroup of patients. 125 The only controlled studies of causes of death that have been done were in small bleeding peptic ulcer cohorts in the early 1990s, and these found mortality was CHAPTER 2: BACKGROUND: Causes of excess death elevated 2 fold for up to 5 years following a bleed, compared to the general population. 9,10,126 Much of this long term increase in mortality appeared related to co-morbidity, particularly cancer and cardiovascular disease 10 and up to 50%…”

Peptic Ulcer Disease in Older People

“…As aspirin has ulcerogenic and antiplatelet effects, it is not surprising that a recent study concluded that continuing aspirin in patients who bled from peptic ulcer disease may increase the risk for recurrent bleeding but this may potentially reduce mortality rates. 27 Some studies have suggested that cardiovascular events or reduced drug efficacy are more frequent in clopidogrel users who take a proton pump inhibitor (often to reduce ulcer/bleeding risk from concomitant aspirin or NSAID use). That increased risk has not been reported with pantoprazole.…”