Deprescription of aspirin for primary prevention is uncommon at discharge in hospitalised patients with gastrointestinal bleeding

Abstract

Summary Background Guidelines recommend against aspirin for primary prevention of cardiovascular events in individuals with a history of gastrointestinal bleeding (GIB). It is unknown how often patients on primary prevention aspirin hospitalised with GIB have aspirin discontinued at discharge. Aims To determine the rate of aspirin deprescription and explore long‐term outcomes in patients taking aspirin for primary prevention of cardiovascular events. Methods We evaluated all patients hospitalised at Yale‐New Haven Hospital between January 2014 and October 2021 with GIB who were on aspirin for primary prevention. Our primary endpoint was the frequency of aspirin deprescription at discharge. Our secondary endpoints were post‐discharge hospitalisations for major adverse cardiovascular events (MACE) or GIB. Time‐to‐event analysis was performed using Kaplan–Meier curves and the log‐rank test. Results We identified 320 patients with GIB on aspirin for primary prevention: median age was 72 (interquartile range [IQR] 61–81) years and 297 (92.8%) were on aspirin 81 mg daily. Only 25 (9.0%) patients surviving their hospitalisation were deprescribed aspirin at discharge. Among 260 patients with follow‐up (median 1103 days; IQR 367–1670), MACE developed post‐discharge in 2/25 (8.0%) with aspirin deprescription versus 37/235 (15.7%) with aspirin continuation (log‐rank p = 0.28). 0/25 patients with aspirin deprescription had subsequent hospitalisation for GIB versus 17/235 (7.2%) who continued aspirin (log‐rank p = 0.13). Conclusions Aspirin for primary cardiovascular prevention was rarely deprescribed at discharge in patients hospitalised with GIB. Processes designed to ensure appropriate deprescription of aspirin are crucial to improve adherence to guidelines, thereby improving the risk–benefit ratio in patients at high risk of subsequent GIB hospitalisations with minimal increased risk of MACE.

Letter: factors influencing discontinuation of aspirin in patients after gastrointestinal bleeding – authors' reply

“…In our manuscript, 2 we provided the causes of gastrointestinal bleeding (GIB) among patients within our cohort who underwent endoscopy in Table 2. Among 172 patients, bleeding from peptic ulcer was the most common cause of bleeding (n = 61, 35.5%), followed by diverticular bleeding (n = 31, 18.0%).…”