Continuation of low-Dose aspirin therapy in peptic ulcer bleeding

January 01, 0001

Continuation of low-Dose aspirin therapy in peptic ulcer bleeding

These investigators from Hong Kong tested whether continuing aspirin therapy with proton-pump inhibitors after endoscopic control of ulcer bleeding was at least as beneficial as stopping aspirin therapy, in terms of recurrent ulcer bleeding in adults with cardiovascular or cerebrovascular diseases. They conducted a parallel randomized, placebo-controlled noninferiority trial in which 78 patients received aspirin, 80 mg/d, and 78 received placebo for 8 weeks immediately after endoscopic therapy. All patients received a 72-hour infusion of pantoprazole followed by oral pantoprazole. All patients completed follow-up.

They found: “156 patients were included in an intention-to-treat analysis. Three patients withdrew from the trial before finishing follow-up. Recurrent ulcer bleeding within 30 days was 10.3% in the aspirin group and 5.4% in the placebo group. Patients who received aspirin had lower all-cause mortality rates than patients who received placebo (1.3% vs. 12.9). Patients in the aspirin group had lower mortality rates attributable to cardiovascular, cerebrovascular, or gastrointestinal complications than patients in the placebo group (1.3% vs. 10.3). The sample size is relatively small, and only low-dose aspirin, 80 mg, was used. Two patients with recurrent bleeding in the placebo group did not have further endoscopy.”

The authors concluded: “Among low-dose aspirin recipients who had peptic ulcer bleeding, continuous aspirin therapy may increase the risk for recurrent bleeding but potentially reduces mortality rates. Larger trials are needed to confirm these findings.”

It’s too soon to draw the conclusion that low-dose aspirin should be prescribed to patients with bleeding ulcers and other cardiovascular risk, but as the authors say a larger trial is certainly indicated.

For the full abstract, click here.

Annals of Internal Medicina 152(1):1-9, 5 January 2010. © 2010 to the American College of Physicians.
Continuation of Low-Dose Aspirin Therapy in Peptic Ulcer Bleeding-A Randomized Trial. Joseph J.Y. Sung, James Y.W. Lau, Jessica Y.L. Ching, et al. Correspondence to Dr. Sung:

Category: D. Digestive, K. Circulatory. Keywords: peptic ulcer, gastrointestinal bleeding, aspirin, proton-pump inhibitors, pantoprazole, mortality, randomized controlled trial
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 26 January 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.