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Continued aspirin use after lower GI bleed increases recurrence, reduces CV events, death
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Continued aspirin use after an episode of lower GI bleeding was associated with a higher risk for recurrent lower GI bleeding, but a lower risk for serious cardiovascular events and death, according to retrospective study data.
Lack of data on these risks in patients who continue to use aspirin after recovering from lower GI bleeding led researchers to analyze registry data from Prince of Wales Hospital in Hong Kong from 295 patients with melena or hematochezia and no upper GI bleeding documented from 2000 through 2007.
Researchers compared lower GI bleeding, serious cardiovascular events and death from other causes over 5 years between patients who used aspirin for less than 20% of the follow-up period (nonusers, n = 121; median follow-up, 1.7 years) and patients who took at least 80 mg aspirin daily for at least half of the follow-up period (aspirin users, n = 174; median follow-up, 2.7 years).
Lower GI bleeding recurred in 18.9% (95% CI, 13.3-25.3) of aspirin users compared with 6.9% (95% CI, 3.2-12.5) of nonusers (P = .007).
However, 22.8% (95% CI, 16.6-29.6) of aspirin users had serious cardiovascular events compared with 36.5% (95% CI, 27.4-45.6) of nonusers (P = .017). Moreover, 8.2% (95% CI, 4.6-13.2) of aspirin users died from other causes compared with 26.7% (95% CI, 18.7-35.4) of nonusers (P = .001).
Multivariable competing-risks regression analysis showed aspirin use was an independent predictor of recurrent lower GI bleeding (sub-distribution HR = 2.76; 95% CI, 1.26-6.07; P = .011), but protected against cardiovascular events (SHR = 0.59; 95% CI, 0.37-0.91; P = .019) and death (SHR = 0.33; 95% CI, 0.17-0.63; P = .001).
Deepak L. Bhatt
This study adds important information to understanding the risks and benefits of aspirin use in patients with lower GI bleeding and a high risk for cardiovascular events, according to a related editorial by Deepak L. Bhatt, MD, MPH, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital Heart & Vascular Center, and professor of medicine at Harvard Medical School, and Richard H. Hunt, MD, of the division of gastroenterology and the Farncombe Family Digestive Health Research Institute at McMaster University Health Science Center in Ontario, Canada.
“This is a carefully done observational study that suggests that patients who have had lower GI bleeds who were on aspirin for cardiovascular indications should be restarted on it as soon as it is safe to do so,” Bhatt told Healio Gastroenterology. “Those patients on aspirin versus those not on aspirin had a higher risk for recurrent lower GI bleeding, not surprisingly. However, they also appeared to have a lower risk for adverse cardiovascular events. Of course, a randomized clinical trial would be the ideal study design, though challenging to do in this patient population. Hopefully in the future, collaborations between gastroenterologists and cardiologists will facilitate clinical trials in areas such as this.” – by Adam Leitenberger
Disclosures: Chan reports he has consulted for Pfizer, Eisai, Takeda and Otsuka; has received an independent research grant from Pfizer; and has received lecture fees from Pfizer, AstraZeneca and Takeda. Please see the full study for a list of all other researchers’ relevant financial disclosures, and see the full editorial for a list of Bhatt’s and Hunt’s relevant financial disclosures.
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