title: Incidence and predictors of upper gastrointestinal bleeding in patients receiving low-dose aspirin for secondary prevention of cardiovascular events in patients with coronary artery disease.
abstract: OBJECTIVE
  The use of low-dose aspirin to prevent cardiovascular disease events is well established. However, the incidence and predictors of upper gastrointestinal bleeding (UGIB) with its use are unknown. We studied prospectively the incidence and outcome of peptic ulceration in low-dose aspirin users.
  
  
  METHODS
  A total of 991 patients with coronary artery disease (CAD) on low-dose aspirin were prospectively followed-up for two years for the occurrence and clinical features of first hospitalized episode of UGIB.
  
  
  RESULTS
  UGIB had a bimodal presentation with 45% occurring within four months of aspirin initiation and had an overall prevalence of 1.5% per year. There was no UGIB-related death. Hypertension (OR = 4.6, 95%CI 1.5-14.7, P = 0.009), history of peptic ulceration (OR = 3.1, 95%CI 1.1-9.0, P = 0.039), tertiary education (OR = 3.08, 95%CI 1.1-9.0, P = 0.039) and higher lean body mass (P = 0.016) were independent factors associated with UGIB. Use of nitrate did not reduce UGIB.
  
  
  CONCLUSIONS
  The incidence of UGIB in patients with CAD on long-term low-dose aspirin is low, but is accompanied with significant morbidity. With prolonged use of aspirin, UGIB continues to be a problem for those with risk factors and especially in patients with a history of peptic ulcers, in which UGIB tends to occur early after aspirin therapy.
authors.affiliation: Division of Cardiology, University Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China.
authors.forename: William
authors.initials: W
authors.lastname: Ng
authors.forename: Wai-Man
authors.initials: WM
authors.lastname: Wong
authors.forename: Wai-Hong
authors.initials: WH
authors.lastname: Chen
authors.forename: Hung-Fat
authors.initials: HF
authors.lastname: Tse
authors.forename: Pui-Yin
authors.initials: PY
authors.lastname: Lee
authors.forename: Kam-Chuen
authors.initials: KC
authors.lastname: Lai
authors.forename: Sheung-Wai
authors.initials: SW
authors.lastname: Li
authors.forename: Matthew
authors.initials: M
authors.lastname: Ng
authors.forename: Kwok-Fai
authors.initials: KF
authors.lastname: Lam
authors.forename: Xi
authors.initials: X
authors.lastname: Cheng
authors.forename: Chu-Pak
authors.initials: CP
authors.lastname: Lau
mesh_terms: D000368:Aged; D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use*; D015992:Body Mass Index; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010437:Peptic Ulcer / Q000150:complications; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention
chemical_list: D001241:Aspirin