title: Discontinuation of low-dose aspirin therapy after peptic ulcer bleeding increases risk of death and acute cardiovascular events.
abstract: OBJECTIVE
  Little is known about how discontinuation of low-dose aspirin therapy after peptic ulcer bleeding affects patient mortality or acute cardiovascular events.
  
  
  METHODS
  We performed a retrospective cohort study by using data from patients who received low-dose aspirin therapy and were treated for bleeding peptic ulcers between 2007 and 2010 at Karolinska University Hospital, Stockholm, Sweden. We used a multivariable Cox regression model to adjust for potential confounders and analyze associations between discontinuation of low-dose aspirin therapy at discharge, death, and acute cardiovascular events.
  
  
  RESULTS
  Of the 118 patients who received low-dose aspirin therapy, the therapy was discontinued for 47 (40%). During a median follow-up period of 2 years after hospital discharge, 44 of the 118 patients (37%) either died or developed acute cardiovascular events. Adjusting for confounders, patients with cardiovascular comorbidities who discontinued low-dose aspirin therapy had an almost 7-fold increase in risk for death or acute cardiovascular events (hazard ratio, 6.9; 95% confidence interval, 1.4-34.8) compared with patients who continued this therapy during the first 6 months of the follow-up period. A corresponding association was not observed among patients without cardiovascular comorbidities when the study began.
  
  
  CONCLUSIONS
  In patients with cardiovascular disease, discontinuation of low-dose aspirin therapy after peptic ulcer bleeding increases risk of death and acute cardiovascular events almost 7-fold.
authors.affiliation: Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Norra Stationsgatan 67, Stockholm, Sweden. maryam.derogar@ki.se
authors.forename: Maryam
authors.initials: M
authors.lastname: Derogar
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sandblom
authors.forename: Lars
authors.initials: L
authors.lastname: Lundell
authors.forename: Nicola
authors.initials: N
authors.lastname: Orsini
authors.forename: Matteo
authors.initials: M
authors.lastname: Bottai
authors.forename: Yunxia
authors.initials: Y
authors.lastname: Lu
authors.forename: Omid
authors.initials: O
authors.lastname: Sadr-Azodi
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications*; D006801:Humans; D008297:Male; D010437:Peptic Ulcer / Q000150:complications*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013548:Sweden; D028761:Withholding Treatment
chemical_list: D001241:Aspirin