The Risk of Lower Gastrointestinal Bleeding in Low-dose Aspirin Users

W.-C. Chen; K.-H. Lin; Y.-T. Huang; T.-J. Tsai; W.-C. Sun; S.-K. Chuah; D.-C. Wu; P.-I. Hsu

Disclosures

Aliment Pharmacol Ther. 2017;45(12):1542-1550. 

In This Article

Results

A total of 53 805 low-dose ASA users and 269 025 controls were included in this study (Figure 1). Table 1 and Table 2 present the baseline characteristics of the two groups. The numbers of patients in the low-dose ASA group who experienced ischaemic stroke and used NSAIDs, COX-2 inhibitors, steroids, SSRIs, alendronate, PPIs, H2RAs, nitrates, calcium channel blockers, warfarin, ticlopidine and clopidogrel were higher than those in the control group.

Figure 1.

Flow chart of the study design. NHIRD, the National Health Insurance Research Database

Incidence and Risk Factors for LGIB in the Whole Population

The low-dose ASA group had a significantly higher incidence of LGIB within 1 year than the control group (0.20% vs 0.06%, P<.0001) (Figure 2). A univariate Cox proportional hazard regression model revealed that low-dose ASA (hazard ratio [HR]: 3.30, 95% confidence interval [CI]: 2.59–4.20, P<.0001), NSAIDs (HR: 24.63, 95% CI: 10.39–58.40, P<.0001), steroids (HR: 37.20, 95% CI: 7.97–173.76, P<.0001), SSRIs (HR: 14.96, 95% CI: 2.01–111.47, P=.0083), PPIs (HR: 23.08, 95% CI: 7.06–75.48, P<.0001), H2RAs (HR: 30.22, 95% CI: 9.01–101.40, P<.0001), nitrates (HR: 4.00, 95% CI: 1.07–14.90, P=.038) and calcium channel blockers (HR: 8.50, 95% CI: 3.25–22.23, P<.0001) were significantly associated with LGIB. After adjustments for significant univariate independent predictors, low-dose ASA, NSAIDs, steroids, SSRIs, PPIs and H2RAs were significantly associated with LGIB ( Table 3 ).

Figure 2.

Cumulative hazard for lower gastrointestinal bleeding in low-dose aspirin users and matched controls. Low-dose aspirin users had a significantly higher incidence of lower gastrointestinal bleeding within 1 year than matched controls

Incidence and Risk Factors for LGIB in Patients Aged ≥75 Years

For patients aged ≥75 years, the low-dose ASA group had a significantly higher incidence of LGIB within 1 year than the control group (1.37% vs 0.29%, P =.0013) (Figure 3). The univariate Cox proportional hazard regression model revealed that low-dose ASA (HR: 4.20, 95% CI: 2.35–7.50, P <.0001), H2RAs (HR: 14.55, 95% CI: 1.59–133.06, P =.018), and calcium channel blockers (HR: 10.09, 95% CI: 1.94–52.48, P=.006) were significantly associated with LGIB. After adjustments for significant univariate independent predictors, only low-dose ASA was significantly associated with LGIB ( Table 4 ).

Figure 3.

Cumulative hazard for lower gastrointestinal bleeding in low-dose aspirin users and matched controls aged ≥75 years. Low-dose aspirin users aged ≥75 years had a significantly higher incidence of lower gastrointestinal bleeding within 1 year than matched controls

Incidence and Risk Factors for LGIB in Patients Aged <75 Years

For patients aged <75 years, the low-dose ASA group had a significantly higher incidence of LGIB within 1 year than the control group (0.17% vs 0.05%, P<.0001) (Figure 4). The univariate Cox proportional hazard regression model revealed that low-dose ASA (HR: 3.14, 95% CI: 2.40–4.09, P<.0001), NSAIDs (HR: 19.79, 95% CI: 8.21–47.68, P<.0001), steroids (HR: 29.03, 95% CI: 6.06–139.02, P<.0001), SSRIs (HR: 14.96, 95% CI: 2.01–111.47, P=.0083), PPIs (HR: 20.08, 95% CI: 6.04–66.71, P<.0001), H2RAs (HR: 38.16, 95% CI: 8.82–156.06, P<.0001) and calcium channel blockers (HR: 7.74, 95% CI: 2.36–25.43, P=.0007) were significantly associated with LGIB. After adjustments for significant variables of univariate independent predictors, low-dose ASA, NSAIDs, steroids, SSRIs, PPIs and H2RAs were significantly associated with LGIB ( Table 5 ).

Figure 4.

Cumulative hazard for lower gastrointestinal bleeding in low-dose aspirin users and matched controls aged <75 years. Low-dose aspirin users aged <75 years had a significantly higher incidence of lower gastrointestinal bleeding within 1 year than matched controls

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