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Risk of Upper Gastrointestinal Bleeding in a Cohort of New Users of Low-Dose ASA for Secondary Prevention of Cardiovascular Outcomes.

Cea Soriano L, Rodríguez LA - Front Pharmacol (2010)

Bottom Line: Concomitant use of ASA and clopidogrel (RR, 1.61; 95% CI, 0.85-3.05) or non-steroidal anti-inflammatory drugs (NSAIDs; RR, 2.92; 95% CI, 1.77-4.82) conferred an increased risk of UGIB compared with ASA monotherapy.Discontinuation of ASA therapy (RR: 0.71, 95% CI, 0.42-1.20) and PPI co-treatment given since the start of ASA therapy (RR, 0.56; 95% CI, 0.33-0.96) were associated with a reduced risk of UGIB.The prescription of PPI therapy at the initiation of low-dose ASA reduced the risk of UGIB by almost half.

View Article: PubMed Central - PubMed

Affiliation: Centro Español de Investigación Farmacoepidemiológica Madrid, Spain.

ABSTRACT
The Health Improvement Network UK primary care database was used to identify a cohort of 38 077 individuals aged 50-84 years with a first prescription of low-dose acetylsalicylic acid (ASA; 75-300 mg/day) for secondary prevention of cardiovascular or cerebrovascular events during 2000-2007. From this cohort, 169 incident cases of upper gastrointestinal bleeding (UGIB) were identified. Controls with no UGIB (n = 2000) were frequency-matched to the cases by age, sex, and follow-up time. A nested case-control analysis was performed to determine risk factors associated with UGIB. The incidence of UGIB was 1.1 per 1000 person-years (95% CI, 1.0-1.3). Low-dose ASA users with a history of peptic ulcer disease had an increased risk of UGIB compared with those without (Relative Risk [RR], 4.59; 95% CI, 2.87-7.33). Concomitant use of ASA and clopidogrel (RR, 1.61; 95% CI, 0.85-3.05) or non-steroidal anti-inflammatory drugs (NSAIDs; RR, 2.92; 95% CI, 1.77-4.82) conferred an increased risk of UGIB compared with ASA monotherapy. Discontinuation of ASA therapy (RR: 0.71, 95% CI, 0.42-1.20) and PPI co-treatment given since the start of ASA therapy (RR, 0.56; 95% CI, 0.33-0.96) were associated with a reduced risk of UGIB. In conclusion, in a cohort of individuals receiving low-dose ASA for secondary prevention of cardiovascular or cerebrovascular events, patients with a history of peptic ulcer disease, or who were receiving clopidogrel or NSAIDs had an increased risk of UGIB. The prescription of PPI therapy at the initiation of low-dose ASA reduced the risk of UGIB by almost half.

No MeSH data available.


Related in: MedlinePlus

Incidence of UGIB by age and sex in a cohort of low-dose ASA users. ASA, acetylsalicylic acid; UGIB, upper gastrointestinal bleeding.
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Figure 2: Incidence of UGIB by age and sex in a cohort of low-dose ASA users. ASA, acetylsalicylic acid; UGIB, upper gastrointestinal bleeding.

Mentions: We observed a crude incidence of UGIB of 1.12 per 1000 person-years (95% CI, 0.96–1.30). The incidence of UGIB increased with age and was slightly higher among men 1.18 (95% CI, 0.97–1.43) than women 1.05 (95% CI, 0.83–1.33) (Figure 2). There was no significant association between UGIB and sex (log rank test pvalue = 0.44), but older age was associated with UGIB (>70 years vs ≤70 years; log rank test pvalue = 0.0003).


Risk of Upper Gastrointestinal Bleeding in a Cohort of New Users of Low-Dose ASA for Secondary Prevention of Cardiovascular Outcomes.

Cea Soriano L, Rodríguez LA - Front Pharmacol (2010)

Incidence of UGIB by age and sex in a cohort of low-dose ASA users. ASA, acetylsalicylic acid; UGIB, upper gastrointestinal bleeding.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3140176&req=5

Figure 2: Incidence of UGIB by age and sex in a cohort of low-dose ASA users. ASA, acetylsalicylic acid; UGIB, upper gastrointestinal bleeding.
Mentions: We observed a crude incidence of UGIB of 1.12 per 1000 person-years (95% CI, 0.96–1.30). The incidence of UGIB increased with age and was slightly higher among men 1.18 (95% CI, 0.97–1.43) than women 1.05 (95% CI, 0.83–1.33) (Figure 2). There was no significant association between UGIB and sex (log rank test pvalue = 0.44), but older age was associated with UGIB (>70 years vs ≤70 years; log rank test pvalue = 0.0003).

Bottom Line: Concomitant use of ASA and clopidogrel (RR, 1.61; 95% CI, 0.85-3.05) or non-steroidal anti-inflammatory drugs (NSAIDs; RR, 2.92; 95% CI, 1.77-4.82) conferred an increased risk of UGIB compared with ASA monotherapy.Discontinuation of ASA therapy (RR: 0.71, 95% CI, 0.42-1.20) and PPI co-treatment given since the start of ASA therapy (RR, 0.56; 95% CI, 0.33-0.96) were associated with a reduced risk of UGIB.The prescription of PPI therapy at the initiation of low-dose ASA reduced the risk of UGIB by almost half.

View Article: PubMed Central - PubMed

Affiliation: Centro Español de Investigación Farmacoepidemiológica Madrid, Spain.

ABSTRACT
The Health Improvement Network UK primary care database was used to identify a cohort of 38 077 individuals aged 50-84 years with a first prescription of low-dose acetylsalicylic acid (ASA; 75-300 mg/day) for secondary prevention of cardiovascular or cerebrovascular events during 2000-2007. From this cohort, 169 incident cases of upper gastrointestinal bleeding (UGIB) were identified. Controls with no UGIB (n = 2000) were frequency-matched to the cases by age, sex, and follow-up time. A nested case-control analysis was performed to determine risk factors associated with UGIB. The incidence of UGIB was 1.1 per 1000 person-years (95% CI, 1.0-1.3). Low-dose ASA users with a history of peptic ulcer disease had an increased risk of UGIB compared with those without (Relative Risk [RR], 4.59; 95% CI, 2.87-7.33). Concomitant use of ASA and clopidogrel (RR, 1.61; 95% CI, 0.85-3.05) or non-steroidal anti-inflammatory drugs (NSAIDs; RR, 2.92; 95% CI, 1.77-4.82) conferred an increased risk of UGIB compared with ASA monotherapy. Discontinuation of ASA therapy (RR: 0.71, 95% CI, 0.42-1.20) and PPI co-treatment given since the start of ASA therapy (RR, 0.56; 95% CI, 0.33-0.96) were associated with a reduced risk of UGIB. In conclusion, in a cohort of individuals receiving low-dose ASA for secondary prevention of cardiovascular or cerebrovascular events, patients with a history of peptic ulcer disease, or who were receiving clopidogrel or NSAIDs had an increased risk of UGIB. The prescription of PPI therapy at the initiation of low-dose ASA reduced the risk of UGIB by almost half.

No MeSH data available.


Related in: MedlinePlus