The risk of lower gastrointestinal bleeding in low‐dose aspirin users

• Published in: Alimentary pharmacology & therapeutics Vol. 45; no. 12; pp. 1542 - 1550
• Main Authors: Chen, W.‐C., Lin, K.‐H., Huang, Y.‐T., Tsai, T.‐J., Sun, W.‐C., Chuah, S.‐K., Wu, D.‐C., Hsu, P.‐I.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.06.2017
• Subjects: Adult; Aged; Aged, 80 and over; Alendronic acid; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Aspirin; Aspirin - administration & dosage; Aspirin - adverse effects; Bisphosphonates; Bleeding; Calcium; Cardiovascular disease; Case-Control Studies; Chronic obstructive pulmonary disease; Cirrhosis; Clopidogrel; Comorbidity; Coronary artery; Cyclooxygenase 2 Inhibitors - therapeutic use; Cyclooxygenase-2; Databases, Factual; Diabetes mellitus; Dose-Response Relationship, Drug; Dyslipidemia; Female; Gastrointestinal Hemorrhage - chemically induced; Gastrointestinal Hemorrhage - epidemiology; Gastrointestinal Hemorrhage - etiology; Health risk assessment; Heart diseases; Hemorrhage; Histamine; Histamine H2 Antagonists - therapeutic use; Humans; Incidence; Inflammation; Liver cirrhosis; Liver diseases; Lung diseases; Male; Middle Aged; Nonsteroidal anti-inflammatory drugs; Obstructive lung disease; Peptic Ulcer - complications; Peptic Ulcer - drug therapy; Peptic Ulcer - epidemiology; Peptic Ulcer Hemorrhage - drug therapy; Peptic Ulcer Hemorrhage - epidemiology; Proton pump inhibitors; Proton Pump Inhibitors - therapeutic use; Regression analysis; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - drug therapy; Renal Insufficiency, Chronic - epidemiology; Risk Factors; Serotonin uptake inhibitors; Serotonin Uptake Inhibitors - therapeutic use; Steroid hormones; Stroke; Taiwan - epidemiology; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; Ulcers; Warfarin; Warfarin - therapeutic use; Young Adult
• ISSN: 0269-2813; 1365-2036; 1365-2036
• DOI: 10.1111/apt.14079

Summary Background Aspirin increases the risk of gastrointestinal bleeding. Aim To investigate the risk of lower gastrointestinal bleeding (LGIB) in aspirin users. Methods Low‐dose (75‐325 mg daily) aspirin users and controls matched by age, gender and enrollment time in a 1:5 ratio were selected from 1 million randomly sampled subjects in the National Health Insurance Research Database of Taiwan. Cox proportional hazard regression models were developed to evaluate the predictors of LGIB with adjustments for age, gender, comorbidities including coronary artery disease, ischaemic stroke, diabetes, hypertension, chronic kidney disease, liver cirrhosis, chronic obstructive pulmonary disease, dyslipidemia, uncomplicated peptic ulcer disease, history of peptic ulcer bleeding, and concomitant use of clopidogrel, ticlopidine, warfarin, nonsteroidal anti‐inflammatory drugs (NSAIDs), cyclooxygenase‐2 inhibitors, steroids, proton pump inhibitors (PPIs), histamine‐2 receptor antagonists (H2RAs), nitrates, alendronate, selective serotonin reuptake inhibitors (SSRIs) and calcium channel blockers. Results A total of 53 805 aspirin users and 269 025 controls were included. Aspirin group had a higher incidence of LGIB within 1 year than control group (0.20% vs 0.06%, P<.0001). Aspirin (hazard ratio [HR]: 2.75, 95% confidence interval [CI]: 2.06‐3.65), NSAIDs (HR: 8.61, 95% CI: 3.28‐22.58), steroids (HR: 10.50, 95% CI: 1.98‐55.57), SSRIs (HR: 11.71, 95% CI: 1.40‐97.94), PPIs (HR: 8.47, 95% CI: 2.26‐31.71), and H2RAs (HR: 10.83, 95% CI: 2.98‐39.33) were significantly associated with LGIB. Conclusions The risk of LGIB was higher in low‐dose aspirin users than in aspirin nonusers in this nationwide cohort. Low‐dose aspirin, NSAIDs, steroids, SSRIs, PPIs and H2RAs were independent risk factors for LGIB. Linked ContentThis article is linked to Taha and Chen et al papers. To view these articles visit https://doi.org/10.1111/apt.14114 and https://doi.org/10.1111/apt.14138.