title: Patterns in the use of low-dose acetylsalicylic acid and other therapies following upper gastrointestinal bleeding.
abstract: BACKGROUND
  Anticoagulants and/or antiplatelet agents such as acetylsalicylic acid (ASA) are important in prevention of cardiovascular (CV) events, but may be associated with upper gastrointestinal bleeding (UGIB). However, discontinuing these agents may leave patients at risk of CV events.
  
  
  OBJECTIVE
  This study aimed to assess patterns of therapy after UGIB in routine clinical practice.
  
  
  METHODS
  The Health Improvement Network UK primary care database was used to identify a cohort of patients aged 40-84 years with a UGIB event between 2000 and 2007 (n = 2,036). Patients were followed up for 1 year from the recorded UGIB. Re-prescription rates for antithrombotics and drugs that can modify the risk of UGIB were estimated at 30, 90, 180, and 365 days.
  
  
  RESULTS
  At 365 days, the re-prescription rate was 43 % for ASA, 66 % for warfarin, 69 % for clopidogrel, and 49 % for dipyridamole. The re-prescription rate of gastroprotective agents at 365 days for current users of histamine H2-receptor antagonists was 36 % and that of proton pump inhibitors (PPIs) was 97 %. In patients who were prescribed ASA before UGIB (n = 572), only 24 % were prescribed a PPI in the previous year. In patients who were prescribed ASA in the year after UGIB (n = 337), 92 % were prescribed a PPI.
  
  
  CONCLUSIONS
  Antiplatelet use fell after UGIB events. In patients who were prescribed a PPI after a UGIB event, there was increased re-prescription of antiplatelet agents and antithrombotics.
authors.affiliation: Spanish Centre for Pharmacoepidemiologic Research (CEIFE), c/Almirante 28, 2°, 28004, Madrid, Spain.
authors.forename: María E
authors.initials: ME
authors.lastname: Sáez
authors.forename: Antonio
authors.initials: A
authors.lastname: González-Pérez
authors.forename: Saga
authors.initials: S
authors.lastname: Johansson
authors.forename: Péter
authors.initials: P
authors.lastname: Nagy
authors.forename: Luis A
authors.initials: LA
authors.lastname: García Rodríguez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000517:prevention & control; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D006635:Histamine H2 Antagonists; D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D001241:Aspirin