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.
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.
Ng
William
W
Division of Cardiology, University Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China.
Wong
Wai-Man
WM
Chen
Wai-Hong
WH
Tse
Hung-Fat
HF
Lee
Pui-Yin
PY
Lai
Kam-Chuen
KC
Li
Sheung-Wai
SW
Ng
Matthew
M
Lam
Kwok-Fai
KF
Cheng
Xi
X
Lau
Chu-Pak
CP
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
D001241:Aspirin