Poor awareness of preventing aspirin-induced gastrointestinal injury with combined protective medications

Abstract

The prescribing pattern of low-dose aspirin revealed a poor awareness of preventing GI injury with combined protective medications. Actions should be taken to address this issue.

Mechanisms, prevention and clinical implications of nonsteroidal anti-inflammatory drug-enteropathy

“…In a recent clinical trial that involved over 1200 patients taking aspirin and another anti-platelet therapy for cardiovascular protection, lower GI bleeding was found to occur 3-times more frequently than upper GI bleeding [12] . Zhu et al [13] reported that only about 3.5% of patients prescribed low-dose aspirin also received a prescription for a proton pump inhibitor (PPI), histamine H2 receptor antagonist (H2RA) or muco-protective drug, suggesting that the prescribing physicians did not recognize the potential for GI adverse effects of low-dose aspirin. The pathogenesis of aspirin-induced small intestinal damage differs in several respects to that of the ulceration caused by other NSAIDs (discussed in more detail below).…”

“…Selective COX-2 inhibitors cause small intestinal damage and bleeding (the latter effect is somewhat surprising given the minimal inhibitory effects these drugs of these drugs on platelet function). McCarthy [3] noted that in the VIGOR study, the majority of the GI bleeds originated from lesions in the small intestine (distal to the ligament of Treitz): 58% of the GI bleeds in patients taking rofecoxib and 52% of the GI bleeds in patients taking naproxen [13] . There are several reasons for the lack of recognition of the prevalence and seriousness of NSAID-enteropa-thy.…”

“…Indeed, antisecretory drugs have been described as "useless either in preventing or treating mucosal lesions" induced by NSAIDs in the intestine [36] . It is worth repeating that the majority of damage and bleeding caused by NSAIDs occurs in the small intestine, distal to the ligament of Treitz [3,13] . Using a rat model, we attempted to replicate common clinical scenarios of polypharmacy to determine the effects on the small intestine [37] .…”

Plasma Levels of Leukotriene B4 and Prostaglandin E2 Correlation with Endoscopic Changes after NSAID Gastropathies Pantoprazole Treatment in Patients with Cardiovascular Pathology

“…There was found a significant decrease of erosions and ulcers after a pantoprazole course assignment in the treatment of NSAID gastropathies [11].…”

“…The cause of gastroduodenal erosive and ulcerative lesions, and bleeding and perforations, associated with it, is NSAIDs receiving, including aspirin [3,4,11].…”