Even low-dose aspirin may increase risk of GI bleeding

For decades, the medical industry has tried to convinced healthy people to take an aspirin a day to prevent cardiovascular disease and cancer. However, according to a new study in Clinical Gastroenterology and Hepatology, the use of low-dose aspirin raises the risk for GI bleeding, with the risk being increased further with accompanying use of cardiovascular disease-preventing therapies, such as clopidogrel and anticoagulants.

Yet, the risks weren’t enough to convince the researchers to change the recommendation altogether. “The use of aspirin has been proven beneficial in reducing cardiac events and deaths in patients who have cardiovascular disease, and has even been shown to reduce cancer risk,” said Angel Lanas, MD, PhD, of University Hospital Lozano Blesa and lead author of this study. “However, clinicians need to be more proactive in their efforts to reduce potential risk factors associated with all doses of aspirin, especially gastrointestinal bleeding. New low-dose aspirin studies should report more precisely on the incidence of bleedings, especially gastrointestinal bleedings, to better determine the balance between risks and benefits.”

Low-dose aspirin – commonly defined as 75 to 325 mg daily – is a mainstay of therapy for cardiovascular disease. It’s likely now to also be used for cancer prevention, especially GI and colon cancer.

A major factor limiting widespread aspirin use is concern about the development of GI adverse events, especially GI bleeding. Damage may vary, however, depending on the dose taken, other medication being consumed along with aspirin and patients’ risk profiles. For example, certain patients have an increased likelihood of experiencing bleeding: those with long-term pharmacotherapy use, patients using combinations of low-dose aspirin with clopidogrel and anticoagulants, and patients with previous GI ulcers or bleedings.

In this study, doctors searched 10 electronic databases and collected data on adverse events in studies that evaluated low doses of aspirin alone or in combination with anticoagulants, clopidogrel or PPIs. They found that low doses of aspirin alone decreased the risk of death. But, the risk of major GI bleeding increased with low doses of aspirin alone compared with placebo. The risk also increased when aspirin was combined with clopidogrel (compared with aspirin alone), anticoagulants versus low doses of aspirin alone, or in studies that included patients with a history of GI bleeding or of longer duration.

SOURCE: Press Release from the American Gastroenterological Association, Sept. 12, 2011, provided information for this article.