Risk of aspirin-associated major upper-gastrointestinal bleeding with enteric-coated or buffered product

Association between aspirin and upper gastrointestinal complications: Systematic review of epidemiologic studies

“…Studies often had the following exclusion criteria: cancer (n=10), oesophageal varices (n=10), Mallory-Weiss disease (n=10), alcoholism (n=7), chronic liver disease (n=7) or/and coagulopathies (n=6). Aspirin exposure was de®ned as use during the last week in nine studies, use in the last month in three studies, and use reaching the index date or prescriptions that would cover the index date in the other 1 2 De Abajo [58] 3 4 5 6 7 8 9 10 11 12 Sorensen [57] García Rodríguez [55] Pérez Gutthan [54] McMahon [52] Hallas [49] Cohorts Lanas [56] Wilcox [53] Matikainen [52] Kelly [51] Weil [48] Savage [47] Henry [46] Keating [45] Nobili [38] Holvoet [44] Laporte [43] Case/control 0 1 3 14 15 2.2 3.1 Figure 1 Relative risks and 95% con®dence interval reported in original publications on aspirin use and UGIC during 1990 ±2001, strati®ed by study design. ®ve studies.…”

“…Five studies addressed the effect of different daily doses of aspirin in their analyses [46±48, 51,58]; all of them found greater risks of UGIC for aspirin doses above 300 mg day x1 than for lower doses. However, the risk was still elevated for doses up to 300 mg day x1 .…”

“…Only four studies reported data on aspirin formulation [48,51,57,58]. The pooled RRs were 2.4 (95% CI: 1.9, 2.9) for coated and 2.6 (95% CI: 2.3, 2.9) for plain preparations.…”

“…When frequency of exposure was investigated, the RR was higher for patients using aspirin regularly (RR=3.2; 95% CI: 2.6, 3.9) than for patients using aspirin occasionally (RR=2.1; 95% CI: 1.7, 2.6) [48,51]. The risk of UGIC associated with aspirin was higher during the ®rst month of use (RR=4.4; 95% CI: 3.2, 6.1) than in the subsequent months of treatment (RR=2.6; 95% CI: 2.1, 3.1) [46,48,58].…”

The impact of bleeding in patients with acute coronary syndromes: How to optimize the benefits of treatment and minimize the risk

“…At higher risk are elderly patients, those with comorbid conditions such heart failure or rheumatoid arthritis, and patients with the concomitant use of corticosteroids, anticoagulants, ethanol and nonsteroidal anti-inflammatory medications (56). Unfortunately, the enteric coating of ASA only lowers the likelihood of erosive gastritis, not the frequency of associated peptic ulceration (57). Among the available strategies to lower the risk of peptic ulceration in patients at high risk of bleeding, the concomitant use of proton pump inhibitors is the most attractive, even leading to healing of ulcers despite continued treatment with ASA (58).…”