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World J Gastroenterol. May 14, 2006; 12(18): 2923-2927
Published online May 14, 2006. doi: 10.3748/wjg.v12.i18.2923
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
William Ng, Wai-Man Wong, Wai-Hong Chen, Hung-Fat Tse, Pui-Yin Lee, Kam-Chuen Lai, Sheung-Wai Li, Matthew Ng, Kwok-Fai Lam, Xi Cheng, Chu-Pak Lau
William Ng, Wai-Hong Chen, Hung-Fat Tse, Pui-Yin Lee, Xi Cheng, Chu-Pak Lau, Division of Cardiology, University Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
Wai-Man Wong, Kam-Chuen Lai, Matthew Ng, Division of Gastroenterology, University Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
Sheung-Wai Li, Division of Rehabilitation Medicine, University Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
Kwok-Fai Lam, Department of Statistics and Actuarial Science, University of Hong Kong, Hong Kong SAR, China
Correspondence to: Professor Chu-Pak Lau, Chief (Academic), Division of Cardiology, University Department of Medicine, 4th floor, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China. cplau@hkucc.hku.hk
Telephone: +852-28554244 Fax: +852-28186304
Received: June 22, 2005
Revised: June 28, 2005
Accepted: August 26, 2005
Published online: May 14, 2006
Abstract

AIM: 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.

CONCLUSION: 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.

Keywords: Coronary artery disease; Aspirin; Gastrointestinal bleeding