823
Views
127
CrossRef citations to date
0
Altmetric
Brief Review

Low-dose aspirin and upper gastrointestinal damage:epidemiology, prevention and treatment

&
Pages 163-173 | Accepted 09 Nov 2006, Published online: 14 Dec 2006

References

  • Simmons DL, Botting RM, Hla T. Cyclooxygenase isozymes: the biology of prostaglandin synthesis and inhibition. Pharmacol Rev 2004;56:387–437
  • Loll PJ, Picot D, Garavoto RM. The structural basis of aspirin activity inferred from the crystal structure of inactivated prostaglandin H2 synthase. Nat Struct Biol 1995;2: 637–43
  • Oullet M, Riendeau D, Percival MD. A high level of cyclooxygenase-2 inhibitor selectivity is associated with a reduced interference of platelet cyclooxygenase-1 inactivation by aspirin. Proc Natl Acad Sci USA 2001;98: 14583–8
  • Kim C, Beckles GL. Cardiovascular disease risk reduction in the Behavioral Risk Factor Surveillance System. Am J Prev Med 2004;27:1–7
  • Antiplatelet Trialists’ Collaboration. Collaborative overview of randomised trials of antiplatelet therapy I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Br Med J 1994;308: 81–106
  • Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Br Med J 2002;324:71–86
  • Ridker PM, Cook NR, Lee IM, et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. New Engl J Med 2005;352:1293–304
  • Pearson TA, Blair SN, Daniels SR, et al. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update. Circulation 2002;106:388–91
  • Hayden M, Pignone M, Phillips C, et al. Aspirin for the primary prevention of cardiovascular events: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002;136:161–72
  • García Rodríguez L A, Jick H. Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs. Lancet 1994;343: 769–72
  • Hawkey CJ, Lanas AI. Doubt and certainty about nonsteroidal anti-inflammatory drugs in the year 2000: a multidisciplinary expert statement. Am J Med 2001;110:79S–100S
  • García Rodríguez LA, Hernandez-Diaz S, de Abajo FJ. Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies. Br J Clin Pharmacol 2001;52:563–71
  • Hoftiezer JW, Silvoso GR, Burks M, Ivey KJ. Comparison of the effects of regular and enteric-coated aspirin on gastroduodenal mucosa of man. Lancet 1980;2:609–12
  • Prichard PJ, Kitchingman GK, Walt RP, et al. Human gastric mucosal bleeding induced by low dose aspirin, but not warfarin. Br Med J 1989;298:493–6
  • Hawthorne AB, Mahida YR, Cole AT, Hawkey CJ. Aspirin-induced gastric mucosal damage: prevention by enteric-coating and relation to prostaglandin synthesis. Br J Clin Pharmacol 1991;32:77–83
  • Petroski D. Endoscopic comparison of three aspirin preparations and placebo. Clin Ther 1993;15:314–20
  • Cryer B, Feldman M. Effects of very low dose daily, long-term aspirin therapy on gastric, duodenal, and rectal prostaglandin levels and on mucosal injury in healthy humans. Gastroenterology 1999;117:17–25
  • Chowdhury A, Ganguly G, Chowdhury D, et al. Gastroduodenal mucosal changes associated with low-dose aspirin therapy: a prospective, endoscopic study. Indian J Gastroenterol 2001;20:227–9
  • Yeomans ND, Lanas AI, Talley NJ, et al. Prevalence and incidence of gastroduodenal ulcers during treatment with vascular protective doses of aspirin. Aliment Pharmacol Ther 2005;22: 795–801
  • Laine L, Maller ES, Chang Y, et al. Ulcer formation with low-dose enteric-coated aspirin and the effect of COX-2 selective inhibition: a double blind trial. Gastroenterology 2004;127:395–402
  • Kelly JP, Kaufman DW, Jurgelon JM, et al. Risk of aspirin-associated major upper-gastrointestinal bleeding with enteric-coated or buffered product. Lancet 1996;348:1413–6
  • de Abajo FJ, García Rodríguez LA. Risk of upper gastrointestinal bleeding and perforation associated with low-dose aspirin as plain and enteric-coated formulations. BMC Clin Pharmacol 2001;1:1
  • Lanas A, Artal A, Blas JM, et al. Effect of parenteral omeprazole and ranitidine on gastric pH and the outcome of bleeding peptic ulcer. J Clin Gastroenterol 1995;21:103–6
  • Hawkey CJ. Non-steroidal anti-inflammatory drug gastropathy: causes and treatment. Scand J Gastroenterol Suppl 1996;220:124–7
  • Roderick PJ, Wilkes HC, Meade TW. The gastrointestinal toxicity of aspirin: an overview of randomised controlled trials. Br J Clin Pharmacol 1993;35:219–26
  • Stalnikowicz-Darvasi R. Gastrointestinal bleeding during low-dose aspirin administration for prevention of arterial occlusive events. A critical analysis. J Clin Gastroenterol 1995;21:13–6
  • Weil J, Colin-Jones D, Langman M, et al. Prophylactic aspirin and risk of peptic ulcer bleeding. Br Med J 1995;310:827–30
  • Derry S, Loke YK. Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis. Br Med J 2000;321:1183–7
  • Baron JA, Cole BF, Sandler RS, et al. A randomized trial of aspirin to prevent colorectal adenomas. New Engl J Med 2003;348:891–9
  • Lanas A, Bajador E, Serrano P, et al. Nitrovasodilators, low-dose aspirin, other nonsteroidal antiinflammatory drugs, and the risk of upper gastrointestinal bleeding. New Engl J Med 2000;343:834–9
  • Sørensen HT, Mellemkjaer L, Blot WJ, et al. Risk of upper gastrointestinal bleeding associated with use of low-dose aspirin. Am J Gastroenterol 2000;95:2218–24
  • Ibáñez L, Vidal X, Vendrell L, et al. Upper gastrointestinal bleeding associated with antiplatelet drugs. Aliment Pharmacol Ther 2006;23:235–42
  • Serebruany VL, Steinhubl SR, Berger PB, et al. Analysis of risk of bleeding complications after different doses of aspirin in 192 036 patients enrolled in 31 randomized controlled trials. Am J Cardiol 2005;95:1218–22
  • Lanas A, Perez-Aisa MA, Feu F, et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gasterenterol 2005;100: 1685–93
  • Goldstein JL, Huang B, Amer F, Christopoulos NG. Ulcer recurrence in high-risk patients receiving nonsteroidal anti-inflammatory drugs plus low-dose aspirin: results of a post hoc subanalysis. Clin Ther 2004;26:1637–43
  • Manes G, Balzano A, Marone P, et al. Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open-access endoscopy system: a prospective observational study based on the Maastricht guidelines. Aliment Pharmacol Ther 2002;16:105–10
  • Holtmann G, Gschossmann J, Buenger L, et al. Do changes in visceral sensory function determine the development of dyspepsia during treatment with aspirin? Gastroenterology 2002;123:1451–8
  • Laine L. Approaches to nonsteroidal anti-inflammatory drug use in the high-risk patient. Gastroenterology 2001;120:594–606
  • Serrano P, Lanas A, Arroyo MT, Ferreira IJ. Risk of upper gastrointestinal bleeding in patients taking low-dose aspirin for the prevention of cardiovascular diseases. Aliment Pharmacol Ther 2002;16:1945–53
  • Silverstein FE, Faich G, Goldstein JL, et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial [Celecoxib Long-term Arthritis Safety Study]. J Am Med Assoc 2000;284:1247–55
  • Schnitzer TJ, Burmester GR, Mysler E, et al. Comparison of lumiracoxib with naproxen and ibuprofen in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET), reduction in ulcer complications: randomised controlled trial. Lancet 2004;364:665–74
  • Hernandez-Diaz S, García Rodríguez LA. Cardioprotective aspirin users and their excess risk of upper gastrointestinal complications. BMC Medicine 2006;4:22
  • Newton JL, Johns CE. May FEl 2004 review article: the ageing bowel and intolerance to aspirin. Aliment Pharmacol Ther 2004;19:39–45
  • Thomopoulos KC, Mimidis KP, Theocharis GJ, et al. Acute upper gastrointestinal bleeding in patients on long-term oral anticoagulation therapy: endoscopic findings, clinical management and outcome. World J Gastroenterol 2005;11:1365–8
  • Lanas A, García Rodríguez LA, Arroyo MT, et al. Risk of upper gastrointestinal ulcer bleeding associated with selective COX-2 inhibitors, traditional non-aspirin NSAIDs, aspirin, and combinations. Gut 2006;55:1731–8
  • McQuaid KR, Laine L. Systematic review and meta-analysis of adverse events of low-dose aspirin and clopidogrel in randomized controlled trials. Am J Med 2006;199:624–38
  • Meschengieser SS, Fondevila CG, Frontroth J, et al. Low-intensity oral anticoagulation plus low-dose aspirin versus high-intensity oral anticoagulation alone: a randomized trial in patents with mechanical prosthetic heart valves. J Thorac Cardiovasc Surg 1997;113:910–6
  • The Medical Research Council’s General Practice Research Framework. Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk. Lancet 1998;351:233–41
  • Hurlen M, Abdelnoor M, Smith P, et al. Warfarin, aspirin or both after myocardial infarction. New Engl J Med 2002;347:969–74
  • Johnson WC, Williford WO, Department of Veterans Affairs Cooperative Study No. 362. Benefits, morbidity and mortality associated with long-term administration of oral anticoagulant therapy to patients with peripheral arterial bypass procedures: a prospective randomized study. J Vasc Surg 2002;35: 413–21
  • Gullov AL, Koefoed BG, Petersen P. Bleeding during warfarin and aspirin therapy in patients with atrial fibrillation: the AFASAK 2 study. Atrial fibrillation aspirin and anticoagulation. Arch Intern Med 1999;159: 1322–8
  • Hunt RH, Bazzoli F. Review article: should NSAID/low-dose aspirin takers be tested routinely for H. pylori infection and treated if positive? Implications for primary risk of ulcer and ulcer relapse after initial healing. Aliment Pharmacol Ther 2004;19: 9–16
  • Chan FK, Chung SC, Suen BY, et al. Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen. New Engl J Med 2001;344:967–73
  • Malfertheiner P, Megraud F, O’Morain C, et al. Current concepts in the management of Helicobacter pylori infection – the Maastricht 2–2000 Consensus Report. Aliment Pharmacol Ther 2002;16: 167–80
  • Lanas A, Fuentes J, Benito R, et al. Helicobacter pylori increases the risk of upper gastrointestinal bleeding in patients taking low-dose aspirin. Aliment Pharmacol Ther 2002;16:779–86
  • Jaspersen D, Koerner T, Schorr W, et al. Helicobacter pylori eradication reduces the rate of rebleeding in ulcer hemorrhage. Gastrointest Endosc 1995;41:5–7
  • Rokkas T, Karameris A, Mavrogeorgis A, et al. Eradication of Helicobacter pylori reduces the possibility of rebleeding in peptic ulcer disease. Gastrointest Endosc 1995;41:1–4
  • Gisbert JP, Boixeda D, Aller R, et al. Helicobacter pylori and digestive hemorrhage due to duodenal ulcer: the prevalence of the infection, the efficacy of 3 triple therapies and the role of eradication in preventing a hemorrhagic recurrence [in Spanish]. Med Clin (Barc) 1999;112:161–5
  • Chan FK, Ching J Suen BY, et al. Eradication of H. pylori for the prevention of recurrent ulcer bleeding in high-risk aspirin users: a 4-year prospective cohort study [abstract]. Gastroenterology 2005;128:A133
  • Lai KC, Lam SK, Chu KM, et al. Lansoprazole for the prevention of recurrences of ulcer complications from long-term low-dose aspirin use. New Engl J Med 2002;346:2033–8
  • Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction – summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol 2002;40:1366–74
  • CAPRIE Steering Committee. A randomised, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996;348:1329–39
  • Ng FH, Wong BC, Wong SY, et al. Clopidogrel plus omeprazole compared with aspirin plus omeprazole for aspirin-induced symptomatic peptic ulcers/erosions with low to moderate bleeding/re-bleeding risk – a single-blind, randomized controlled study. Aliment Pharmacol Ther 2004;19:359–65
  • Ma L, Elliott SN, Cirino G, et al. Platelets modulate gastric ulcer healing: role of endostatin and vascular endothelial growth factor release. Proc Natl Acad Sci USA 2001;98:6470–5
  • Hallas J, Dall M, Andries A, et al. Use of single and combined antithrombotic therapy and risk of serious upper gastrointestinal bleeding: population based case-control study. Br Med J 2006;333:726
  • Elliott SL, Ferris RJ, Giraud AS, et al. Indomethacin damage to rat gastric mucosa is markedly dependent on luminal pH. Clin Exp Pharmacol Physiol 1996;23:432–4
  • Donnelly MT, Goddard AF, Filipowicz B, et al. Low-dose misoprostol for the prevention of low-dose aspirin-induced gastroduodenal injury. Aliment Pharmacol Ther 2000;14:529–34
  • Silverstein FE, Graham DY, Senior JR, et al. Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal anti-inflammatory drugs. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1995;123:241–9
  • Kitchingman GK, Prichard PJ, Daneshmend TK, et al. Enhanced gastric mucosal bleeding with doses of aspirin used for prophylaxis and its reduction by ranitidine. Br J Clin Pharmacol 1989;28:581–5
  • Cole AT, Brundell S, Hudson N, et al. Ranitidine: differential effects on gastric bleeding and mucosal damage induced by aspirin. Aliment Pharmacol Ther 1992;6:707–15
  • Hudson N, Murray FE, Cole AT, et al. Ranitidine bismuth citrate and aspirin-induced gastric mucosal injury. Aliment Pharmacol Ther 1993;7:515–21
  • Lanas A, García-Rodríguez LA, Arroyo MT, et al. Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with NSAIDs and anti-platelet agents. Gastroenterology 2006;130(Suppl 2):82(A563)
  • Yeomans ND, Tulassay Z, Juhasz L, et al. A comparison of omeprazole with ranitidine for ulcers associated with nonsteroidal antiinflammatory drugs. Acid Suppression Trial: Ranitidine versus Omeprazole for NSAID-associated Ulcer Treatment (ASTRONAUT) Study Group. New Engl J Med 1998;338:719–26
  • Simon B, Elsner H, Muller P. Protective effect of omeprazole against low-dose acetylsalicylic acid. Endoscopic controlled double-blind study in healthy subjects. Arzneimittelforschung 1995;45:701–3
  • Muller P, Fuchs W, Simon B. Studies on the protective effect of lansoprazole on human gastric mucosa against low-dose acetylsalicylic acid. An endoscopic controlled double-blind study. Arzneimittelforschung 1997;47:758–60
  • Lanas A, Rodrigo L, Marquez JL, et al. Low frequency of upper gastrointestinal complications in a cohort of high-risk patients taking low-dose aspirin or NSAIDS and omeprazole. Scand J Gastroenterol 2003;38:693–700
  • Chan FK, Ching JY, Hung LC, et al. Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. New Engl J Med 2005;352:238–44
  • Lai KC, Chu KM, Hui WM, et al. Esomeprazole with aspirin versus clopidogrel for prevention of recurrent gastrointestinal ulcer complications. Clin Gastroenterol Hepatol 2006;4: 860–5
  • Laine L. Proton pump inhibitor co-therapy with nonsteroidal anti-inflammatory drugs – nice or necessary? Rev Gastroenterol Disord 2004;4:S33–S41
  • Bresalier RS, Sandler RS, Quan H, et al. Cardiovascular events associated with rofecoxib in a colorectal adenoma chemo-prevention trial. New Engl J Med 2005;352:1092–102
  • Nussmeier NA, Whelton AA, Brown MT, et al. Complications of the COX-2 inhibitors parecoxib and valdecoxib after cardiac surgery. New Engl J Med 2005;352:1081–91
  • Solomon SD, McMurray JJ, Pfeffer MA, et al. Cardiovascular risk associated with celecoxib in a clinical trial for colorectal adenoma prevention. New Engl J Med 2005; 352:1071–80
  • Lanas A, Hunt R. Prevention of anti-inflammatory drug induced gastrointestinal damage: benefits and risks of therapeutic strategies. Ann Med 2006;38:415–28
  • Goldstein JL, Aisenberg J, Berger M, Dodge WE. Effect of concomitant aspirin (81 mg qd) on incidence of gastric and/or duodenal ulcers in healthy subjects taking celecoxib or naproxen: a randomized, placebo-controlled trial. Gastroenterology 2006;130(Suppl 2):81(A562)
  • US Food and Drug Administration. COX-2 selective (includes Bextra, Celebrex and Vioxx) and non-selective non-steroidal anti-inflammatory drugs (NSAIDS). Available at: www.fda.gov/cder/drug/infopage/cox2/ [last accessed 9 November 2006]
  • Lanas A, Bajador E, Serrano P, et al. Effects of nitrate and prophylactic aspirin on upper gastrointestinal bleeding: a retrospective case-control study. J Int Med Res 1998;26: 120–8
  • Chiroli V, Benedini F, Ongini E, Del Soldato P. Nitric oxide-donating non-steroidal anti-inflammatory drugs: the case of nitroderivatives of aspirin. Eur J Med Chem 2003;38:441–6
  • Whittle BJ. Cyclooxygenase and nitric oxide systems in the gut as therapeutic targets for safer anti-inflammatory drugs. Curr Opin Pharmacol 2004;4:538–45

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.