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Minimizing Risk for Aspirin-Associated GI Complications in CVD Patients
Most patients who receive aspirin for cardioprotection are at risk for aspirin-associated GI complications, but only about 25% receive PPIs or misoprostol to reduce this risk.
Aspirin is commonly used for cardioprotection but, even at low doses, can increase the risk for gastrointestinal ulcers and bleeding. Several factors increase the risk for these complications, including age older than 70, anticoagulation therapy, use of nonsteroidal anti-inflammatory drugs (NSAIDs), and history of GI bleeding, peptic ulcer disease, or other substantial comorbidity. In contrast, proton-pump inhibitor (PPI) use reduces the risk for these complications. To determine the prevalence of risk factors and PPI use among patients taking aspirin for cardioprotection, investigators reviewed the records of 324 patients admitted to a Canadian hospital with a diagnosis of cardiovascular disease.
Ninety-four percent of the patients were taking aspirin when they were discharged. Seventy-eight percent had at least one risk factor for aspirin-associated GI complications, and 15% had at least three risk factors. Nevertheless, only 24% of aspirin users were prescribed PPIs at hospital discharge. An additional 10% were prescribed H2-receptor antagonists, and 0.3% were given misoprostol. The authors concluded that most high-risk aspirin users with cardiovascular disease do not receive gastroprotective therapy.
Comment: Acid-reduction medications are among the most overused drugs in hospitalized patients, but they are underused in patients who are at substantial risk for developing life-threatening GI bleeding from outpatient therapy. The risk factors evaluated in this study have repeatedly been shown to increase the risk for bleeding in patients who take aspirin and NSAIDs. Both PPIs and misoprostol lower the risk for bleeding in high-risk patients. However, as this study illustrates, these drugs are usually not prescribed. Low-dose aspirin might be associated with less risk than full-dose NSAIDs, but it can still cause GI bleeding. The magnitude of this risk in different patient populations and the cost-effectiveness of routine PPI therapy should be evaluated further.
— David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)
Published in Journal Watch Gastroenterology May 9, 2006
Citation(s):
Targownik LE and Al-Mamfud A. The prevalence of risk factors for gastrointestinal complications and use of gastroprotection among persons hospitalized for cardiovascular disease. Aliment Pharmacol Ther 2006 Mar 15; 23:743-9.
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