Gastrointestinal bleeding associated with low-dose aspirin use: relevance and management in clinical practice

Expert Opinion on Drug Safety
A Lanas

Abstract

Aspirin reduces the risk of cardiovascular events, but it is well documented that it can also damage the gastrointestinal (GI) tract. However, the reasons why some people develop serious lesions, whereas most only have minor, clinically irrelevant lesions are poorly understood. A number of risk factors can be used to determine which patients are more likely to develop aspirin-associated GI bleeding, mainly in the upper GI tract; these include a previous GI ulcer, ulcer complications, dyspepsia, and concomitant drug therapy with non-steroidal anti-inflammatory drugs (NSAIDs) or clopidogrel. The possible role of Helicobacter pylori infection is also considered. Aspirin-induced GI damage can be reduced, and a number of strategies can be implemented to shift the risk-benefit ratio in favour of aspirin. Proton pump inhibitors are more effective than H(2)-receptor antagonists in preventing dyspeptic symptoms, peptic ulcers and bleeding ulcers in aspirin users. Although H. pylori infection may be a risk factor of aspirin-induced ulcer bleeding, the role of its eradication in the prevention of this outcome requires further investigation. The individual assessment of the benefits and risks with aspirin, based on the underlying GI and ca...Continue Reading

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Citations

May 17, 2013·Drugs·Rubén Casado-ArroyoAngel Lanas
Jun 8, 2011·Nature Reviews. Gastroenterology & Hepatology·Carlos Sostres, Angel Lanas
Nov 11, 2010·Journal of Gastroenterology and Hepatology·Neville D Yeomans
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May 1, 2012·Best Practice & Research. Clinical Gastroenterology·Rubén Casado-ArroyoAngel Lanas Arbeloa
May 1, 2012·Best Practice & Research. Clinical Gastroenterology·En-Ling Leung Ki, Francis K L Chan
Feb 19, 2013·Alimentary Pharmacology & Therapeutics·A LanasR Casado-Arroyo
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