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Discontinuation of aspirin regimen for bleeding peptic ulcers increased risk for death, cardiovascular events
Patients with bleeding peptic ulcers who discontinued a low-dose regimen of aspirin after hospitalization for the condition were at greater risk for acute cardiovascular events and death in a recent study.
Researchers evaluated data from 118 patients treated for bleeding peptic ulcers at a Swedish hospital between 2007 and 2010. All participants had been on a low-dose (75 mg/day or 160 mg/day) aspirin regimen before being hospitalized, which was discontinued upon discharge in 47 cases. Incidence of death and cardiovascular events, including acute myocardial infarction, ischemic stroke or transient ischemic attack, was observed over a median follow-up of 24.4 months.
Death occurred in 37 cases, including 15 participants who had discontinued aspirin therapy and 22 who had continued. Ten patients experienced cardiovascular events — five had myocardial infarctions, three ischemic strokes and two transient ischemic attacks. No deaths or cardiovascular events occurred in patients aged 63 years and younger.
Among patients with cardiovascular comorbidities, incidence of death and cardiovascular events was significantly greater among patients who discontinued aspirin (31% vs. 8%, P<.01) within the first 6 months of follow-up. No significant difference was observed between groups after 6 months (39% vs. 40%, P=.95). Patients without cardiovascular comorbidities neither died nor experienced cardiovascular events within the first 6 months, regardless of aspirin use. After 6 months, more participants who discontinued therapy died or experienced cardiovascular events, but the difference was not statistically significant (24% vs. 14%, P=.70).
Patients who had discontinued aspirin therapy within the first 6 months of follow-up were at increased risk for either death or cardiovascular events (adjusted HR=6.9; 95% CI, 1.4-34.8), according to multivariate analysis. Stratification based on cardiovascular comorbidities present at baseline indicated that the risk was elevated only for patients with comorbidities (adjusted HR=6.8; 95% CI, 1.3-35.4).
“Discontinuation of aspirin therapy after peptic ulcer bleeding treatment was found to be a strong risk factor for mortality and acute cardiovascular events during the first 6 months of follow-up in patients with cardiovascular comorbidities,” the researchers wrote. “In patients with cardiovascular comorbidities who are treated for peptic ulcer bleeding, aspirin therapy should not be discontinued at the time of discharge from hospital.”