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aspirin and gastrointestinal bleeding

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7601. Secondary stroke prevention with low-dose aspirin, sustained release dipyridamole alone and in combination. ESPS Investigators. European Stroke Prevention Study. (Abstract)

are highly significant in comparison with placebo. As expected, there were enhanced reports of alimentary side-effects in the aspirin groups and also enhanced bleeding. Dipyridamole was associated with a slight increase in headache, which resolved in most patients if therapy was continued. The conclusions are that 50 mg/day of aspirin alone or 400 mg/day of sustained release dipyridamole alone are equally effective in stroke and TIA prevention. When used in combination the effects were additive and were (...) Secondary stroke prevention with low-dose aspirin, sustained release dipyridamole alone and in combination. ESPS Investigators. European Stroke Prevention Study. Patients who had survived a stroke or transient ischaemic attacks (TIA) were admitted to a trial of low-dose aspirin (50 mg) alone, sustained release dipyridamole (400 mg/day) alone, or a combination of the two agents, and results compared with a placebo over 24 months. This low-dose aspirin regimen produced in pairwise comparisons

1998 Thrombosis research Controlled trial quality: uncertain

7602. Use of synthetic prostaglandin E1 (misoprostol) for prevention of aspirin-induced gastroduodenal ulceration in arthritic dogs. (Abstract)

, and prevalence of clinical signs of gastrointestinal disturbance over a 14-day treatment period. The misoprostol/aspirin-treated group had significantly (P < 0.05) less gastroduodenal hemorrhage and ulceration and a significantly (P < 0.05) lower prevalence of vomiting than did the control group. (...) Use of synthetic prostaglandin E1 (misoprostol) for prevention of aspirin-induced gastroduodenal ulceration in arthritic dogs. A randomized, double-blind, controlled study was performed with 18 arthritic dogs administered aspirin (25 mg/kg of body weight, PO, q 8 h) and excipient (control group) or aspirin and misoprostol (100 micrograms, PO, q 8 h). Dogs in the misoprostol (n = 10) and control (n = 8) groups were primarily compared by use of sequential gastroduodenoscopy, changes in PCV

1993 Journal of the American Veterinary Medical Association Controlled trial quality: uncertain

7603. Adverse effects of low-dose aspirin in a healthy elderly population. (Abstract)

with medication, assessed by pill count, was 86%. Gastrointestinal symptoms were reported by 18% (n = 36) of participants receiving aspirin and 13% (n = 26) of those receiving placebo. Clinically evident gastrointestinal bleeding occurred in 3% (n = 6) of subjects receiving aspirin and none receiving placebo. Aspirin-treated subjects had a significant decrease in mean hemoglobin levels of 0.33 gm/dl during the 12-month study period, which was significantly greater than the decrease in the placebo-treated (...) Adverse effects of low-dose aspirin in a healthy elderly population. The adverse effects of low-dose aspirin (100 mg daily) in the elderly were studied over a 12-month period in a double-blind, randomized, placebo-controlled trial of 400 subjects who were 70 years of age or older and had no preexisting major vascular diseases at the time of entry. Subjects were randomized so that 200 subjects received low-dose enteric-coated aspirin (100 mg daily) and 200 subjects received placebo. Compliance

1993 Clinical pharmacology and therapeutics Controlled trial quality: predicted high

7604. Results of the CAPRIE trial: efficacy and safety of clopidogrel. Clopidogrel versus aspirin in patients at risk of ischaemic events. (Full text)

years. The primary outcome measurement was an aggregate of myocardial infarction, ischemic stroke and vascular death. Event rates of 5.32% and 5.83% were associated with clopidogrel and aspirin therapy, respectively. Clopidogrel therapy resulted in a relative risk reduction of 8.7% (CI 0.3-16.5%) compared with aspirin therapy (p = 0.043). Gastrointestinal hemorrhages occurred in 1.99% of patients treated with clopidogrel and 2.66% of patients treated with aspirin (p < 0.002). There were (...) Results of the CAPRIE trial: efficacy and safety of clopidogrel. Clopidogrel versus aspirin in patients at risk of ischaemic events. The recent CAPRIE trial (clopidogrel versus aspirin in patients at risk of ischaemic events) compared clopidogrel with aspirin in reducing the risk of vascular events in 19,185 patients with clinical manifestations of atherosclerosis. Participants were randomized to receive daily oral clopidogrel (75 mg) or aspirin (325 mg). Treatment periods ranged from 1 to 3

1998 Vascular medicine (London, England) Controlled trial quality: uncertain PubMed abstract

7605. Placebo-controlled trial of enteric coated aspirin in coronary bypass graft patients. Effect on graft patency. (Abstract)

). There was more postoperative blood loss, on average, in patients treated with aspirin, but the difference was not significant. Only one patient was withdrawn from long-term therapy because of possible gastrointestinal symptoms; most withdrawals from the trial were necessitated by commencement of aspirin or non-steroidal anti-inflammatory therapy for musculo-skeletal disorders.The coronary bypass graft occlusion rate six months after surgery was low, and was lower on average in aspirin treated subjects (...) Placebo-controlled trial of enteric coated aspirin in coronary bypass graft patients. Effect on graft patency. To determine whether slow-release enteric coated aspirin (100 mg daily), commenced before operation, improves the patency of saphenous vein (SV) coronary artery bypass grafts at six months.Double-blind, randomised, placebo-controlled study at a teaching hospital.One hundred and forty patients were randomly allocated to receive enteric coated aspirin or matching placebo. Similar groups

1993 The Medical journal of Australia Controlled trial quality: predicted high

7606. Platelet disorders in uraemia before and after haemodialysis under the influence of low dose aspirin. (Abstract)

Platelet disorders in uraemia before and after haemodialysis under the influence of low dose aspirin. Thrombocyte dysfunction and increased bleeding time (BT) are well documented in uraemic patients. However, these patients are frequently medicated with low dose aspirin (ASA) in order to maintain shunt patency and prevent cardiovascular events. Recently, life- threatening gastrointestinal haemorrhage in an uraemic subject taking low dose aspirin has been reported. In this work ASA related (...) bleeding risk in uraemic patients and the effect of haemodialysis on their bleeding tendency was studied by measuring in vitro bleeding time (BT) using the Thrombostat 4000 in 34 uraemic patients on chronic haemodialysis compared to 50 healthy subjects. Our results indicate that low dose aspirin does not influence uraemic thrombopathia 8 to 10h after ingestion but seems to increase bleeding risk shortly after ingestion. Moreover, haemodialysis alters uraemic in vitro BT with regard to the time after

1995 Thrombosis research Controlled trial quality: uncertain

7607. Fecal hemoglobin excretion in elderly patients with atrial fibrillation: combined aspirin and low-dose warfarin vs conventional warfarin therapy. (Abstract)

Fecal hemoglobin excretion in elderly patients with atrial fibrillation: combined aspirin and low-dose warfarin vs conventional warfarin therapy. Antithrombotic prophylaxis using combined aspirin and low-dose warfarin is under evaluation in several clinical trials. However, therapy may result in increased gastrointestinal blood loss and clinical bleeding vs conventional single-agent antithrombotic therapy.To assess differences in gastrointestinal blood loss, we measured quantitative fecal (...) , suggesting the potential for increased gastrointestinal hemorrhage.

1996 Archives of internal medicine Controlled trial quality: uncertain

7608. Effects of cutaneous aspirin on the human stomach and duodenum. (Abstract)

Effects of cutaneous aspirin on the human stomach and duodenum. Oral aspirin blocks cyclooxygenase in platelets, lowering serum thromboxane concentrations. Oral aspirin also blocks cyclooxygenase in the gastrointestinal mucosa, lowering prostaglandin production and increasing the risk of gastrointestinal ulceration and bleeding. Aspirin placed on the skin also inhibits cyclooxygenase in platelets, but aspirin absorption through skin is slow, which may minimize the gastrointestinal effects. Our (...) (by 49%-71%); placebo had no effect. Moreover, cutaneous aspirin, but not placebo, resulted in significant gastric mucosal injury. These findings demonstrate that even tiny amounts of aspirin in the blood (2 microM) have inhibitory effects on prostaglandin production in the human stomach and duodenum that result in gastric mucosal damage, even without direct exposure of the stomach to aspirin.

1999 Proceedings of the Association of American Physicians Controlled trial quality: uncertain

7609. [Secondary prevention of ischemic strokes: effect of dosage of aspirin]. (Abstract)

[Secondary prevention of ischemic strokes: effect of dosage of aspirin]. The value of acetylsalicylic acid (ASS) in the secondary prevention of ischemic stroke is well established. However, the optimum dose of AAS for stroke-threatened patients remains unsettled. This paper reviews the pattern of adverse reactions to AAS and their relationship to the dosage of ASS evaluated.All the clinical trials in which AAS was used as the sole antiaggregant in the secondary prevention of ischemic stroke (...) were reviewed. The crude odds ratio for the different adverse reactions was calculated using three sub tests: AAS versus placebo; AAS < 330 mg/d versus AAS > 330 mg/d; and each dosage level versus a placebo.There is an increased risk associated with the use of AAS as compared to a placebo with respect to gastrointestinal bleeding (OR 2.3, IC 95% (1.6-4.1)), peptic ulcer (10.1 (2.5-85.2)), intracerebral hemorrhage (2.2 (1.3-4)) and other hemorrhagic phenomena (2.6 (2-3.3)).There seems to be a direct

1997 Revista de neurologia Controlled trial quality: uncertain

7610. Low-intensity oral anticoagulation plus low-dose aspirin versus high-intensity oral anticoagulation alone: a randomized trial in patients with mechanical prosthetic heart valves. (Full text)

Low-intensity oral anticoagulation plus low-dose aspirin versus high-intensity oral anticoagulation alone: a randomized trial in patients with mechanical prosthetic heart valves. Mechanical heart valve replacement requires lifelong anticoagulant treatment. Aspirin has proved useful in further reducing thromboembolic events when added to oral anticoagulants. However, increased (gastrointestinal) bleeding was observed at the doses previously tested for this combination in heart valve (...) -up was 23 months. The two treatments offered similar antithrombotic protection. The incidence of embolic episodes was 1.32 per 100 patient-years (95% confidence interval 0.53 to 2.7) for arm A and 1.48 per 100 patient-years (95% confidence interval 0.59 to 3.03) for arm B. Major hemorrhage occurred in 1.13 per 100 patient-years (95% confidence interval 0.41 to 2.45) for arm A and 2.33 per 100 patient-years (95% confidence interval 1.17 to 4.14) for arm B. Gastrointestinal bleeding

1997 The Journal of thoracic and cardiovascular surgery Controlled trial quality: uncertain PubMed abstract

7611. Early and long-term (one-year) effects of the association of aspirin and oral anticoagulant on thrombi and morbidity after replacement of the mitral valve with the St. Jude medical prosthesis: a clinical and transesophageal echocardiographic study. (Abstract)

, there was a high and comparable incidence of strands in the two groups (group A+: 44%, 58%; group A-: 49%, 63%). However, the incidence of nonobstructive periprosthetic valve thrombi was significantly lower in group A+ at 9 days: 5% versus 13%, p = 0.03. Total thromboembolic events were reduced in group A+ (9% vs. 25%, p = 0.004) although there was an increased incidence of gastrointestinal hemorrhage (7% vs. 0%). Overall mortality was 9% in group A+ and 4% in group A-. Valve-related events were similar (...) in both groups. Early thrombi, but not strands, were associated with higher morbidity, especially thromboembolic events (30% vs. 13%, p = 0.003).One year after MMVR, the association of aspirin with OAC reduced thrombi and thromboembolic events, but not morbidity, due to an increase in hemorrhagic complications.

2000 Journal of the American College of Cardiology Controlled trial quality: uncertain

7612. Gastroduodenal tolerance of 75 mg clopidogrel versus 325 mg aspirin in healthy volunteers. A gastroscopic study. (Abstract)

Gastroduodenal tolerance of 75 mg clopidogrel versus 325 mg aspirin in healthy volunteers. A gastroscopic study. Clopidogrel is a new antiplatelet agent that offers increased protection over aspirin in preventing vascular ischaemic events in patients with symptomatic atherosclerosis. In a large, randomized, international study of clopidogrel and aspirin (n = 19,185 patients) clopidogrel was associated with a lower incidence of gastrointestinal adverse events, including gastrointestinal (...) haemorrhage and hospitalizations because of gastrointestinal haemorrhage. The aim of the study was to determine whether macroscopic differences in the gastric mucosa between aspirin- and clopidogrel-treated subjects could be detected by gastroscopy after short-term treatment.Thirty-six healthy volunteers were randomized in a double-blind, double-dummy, parallel design, to 75 mg/day of clopidogrel or 325 mg/day of aspirin for 8 days. Gastroscopy was performed at base line before administration of study

2000 Scandinavian journal of gastroenterology Controlled trial quality: uncertain

7613. Thienopyridines or aspirin to prevent stroke and other serious vascular events in patients at high risk of vascular disease? A systematic review of the evidence from randomized trials. (Full text)

comparing either ticlopidine or clopidogrel with aspirin for patients at high risk of vascular disease. The primary outcome was vascular events (stroke, myocardial infarction, or vascular death). Adverse outcomes were intracranial and extracranial hemorrhage, upper and lower gastrointestinal disturbances, neutropenia, thrombocytopenia, and skin rash.In 4 trials among 22 656 patients (including 9840 presenting with a transient ischemic attack/ischemic stroke), the thienopyridines reduced the odds (...) of a vascular event by 9% (odds ratio 0.91, 95% CI 0.84 to 0. 98; 2P=0.01), preventing 11 (95% CI 2 to 19) events per 1000 patients treated for approximately 2 years. The thienopyridines produced significantly less gastrointestinal hemorrhage and upper gastrointestinal upset (indigestion/nausea/vomiting) than did aspirin. Both thienopyridines increased the odds of skin rash and of diarrhea (ticlopidine by approximately 2-fold and clopidogrel by approximately one third). Only ticlopidine increased the odds

2000 Stroke PubMed abstract

7614. Coagulation, fibrinolytic and platelet function in patients on long-term therapy with aspirin 300 mg or 1,200 mg daily compared with placebo. (Abstract)

of haemostatic and platelet functions in 49 patients with transient ischaemic attacks randomly allocated to aspirin 300 mg a day, aspirin 1,200 mg a day or placebo. All had been taking their allocated treatment for between 9 months and 4 years prior to investigation. Bleeding time was prolonged, serum thromboxane diminished and platelet aggregation to arachidonic acid but not ADP was abolished by both 300 mg and 1,200 mg aspirin, in a non-dose dependent fashion. Serum salicylate increased with the dose (...) aspirin causes greater gastro-intestinal blood loss.

1990 Thrombosis and haemostasis Controlled trial quality: uncertain

7615. Protective effect of enprostil against aspirin-induced gastroduodenal mucosal injury in man. Comparison with cimetidine and sucralfate. (Abstract)

with one of the following regimens: enprostil 35 micrograms twice daily; enprostil 35 micrograms in the morning; cimetidine 200 mg three times daily and 400 mg at night; sucralfate 1 g four times daily; or placebo. In the second week, aspirin (900 mg three times daily) was also administered. Endoscopies were performed before and after the aspirin phase of the study, and lesions (mucosal erosions plus submucosal hemorrhages) were counted in the stomach and duodenal bulb. All treatments were superior (...) to placebo (p less than 0.05). The mean number of lesions in the 70-micrograms enprostil group (8.5) was significantly less than in the 35-micrograms enprostil group, (11.1), the sucralfate group (12.4), or the placebo group (16.0); the benefit over cimetidine (10.1), however, was not statistically significant. The protective effect of enprostil was greatest in the antrum, the site of maximal mucosal injury. Gastrointestinal side effects were reported in all groups, though abdominal pain and dyspepsia

1986 The American journal of medicine Controlled trial quality: uncertain

7616. Therapy of symptomatic pericarditis after myocardial infarction: retrospective and prospective studies of aspirin, indomethacin, prednisone, and spontaneous resolution. (Abstract)

in similar patients. In the retrospective study, 36 episodes of symptomatic PMIP in 34 patients were identified; in the prospective study, 25 episodes of PMIP in 24 patients occurred. Relief from the discomfort of PMIP was noted within 48 hours in almost all patients with either indomethacin or aspirin therapy. Minor gastrointestinal bleeding developed in two patients in the retrospective study and in two patients in the prospective study. In the retrospective study, mild discomfort of PMIP abated within (...) Therapy of symptomatic pericarditis after myocardial infarction: retrospective and prospective studies of aspirin, indomethacin, prednisone, and spontaneous resolution. We studied the efficacy of aspirin and indomethacin therapy in relieving the discomfort of postmyocardial infarction pericarditis (PMIP) in two studies: (1) a retrospective evaluation of patients with symptomatic PMIP during a 5-year period and (2) a prospective, randomized, single-blind comparison of aspirin and indomethacin

1981 American heart journal Controlled trial quality: uncertain

7617. Gastro-duodenal mucosal changes associated with low-dose aspirin therapy: a prospective, endoscopic study. (Abstract)

Gastro-duodenal mucosal changes associated with low-dose aspirin therapy: a prospective, endoscopic study. The association of low-dose aspirin use and gastro-intestinal bleeding is well described. However, the gastroduodenal mucosal changes associated with low-dose aspirin therapy have not been properly evaluated. We undertook a prospective, endoscopic study to evaluate gastro-duodenal mucosal lesions produced by low-dose aspirin.Forty-seven patients with non-hemorrhagic cerebral infarct (...) or transient ischemic attacks and normal upper gastrointestinal endoscopy were randomized to receive either enteric-coated (n=25) or plain (n=22) aspirin (150 mg/day). Follow-up endoscopy was done at 2, 4 and 8 weeks; gastro-duodenal mucosal lesions, if present, were scored. Forty-seven patients with hemorrhagic infarct who were not treated with aspirin served as controls.Twenty eight (60%) of 47 patients receiving aspirin had mucosal lesions; stomach alone was the most frequent site (32%), followed

2002 Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology Controlled trial quality: uncertain

7618. Open access gastroscopy findings are unrelated to the use of aspirin and non-steroidal anti-inflammatory drugs. (Full text)

in the frequency of ulcer disease when age-matched groups were compared. Although NSAIDs and aspirin are frequently implicated in gastrointestinal bleeding in the elderly, patients referred for investigation of dyspepsia show no increase in major endoscopic pathology. (...) Open access gastroscopy findings are unrelated to the use of aspirin and non-steroidal anti-inflammatory drugs. This study aims to determine whether priority should be given to patients taking non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin when selecting which dyspeptic patients to refer for open access gastroscopy. A total of 8156 patients underwent gastroscopy, all of whom had upper gastrointestinal symptoms. Patients taking NSAIDs or aspirin showed no significant differences

1997 The British Journal of General Practice PubMed abstract

7619. Aspirin use and chronic diseases: a cohort study of the elderly. (Full text)

, and vitamin supplements. In all 61% responded (13,987, 8881 women and 5106 men; median age 73). They formed the cohort that was followed up for 6 1/2 years using discharge summaries from three hospitals serving the area and death certificates from the health department. Only 13 respondents were lost to follow up but seemed not to have died.Incidences of cardiovascular diseases, cancers, gastrointestinal bleeding, ulcers, and cataracts were compared in participants who did and did not take aspirin (...) with those who did not take it, although the increase was significant only in men (relative risks = 6.3, 95% confidence interval 2.2 to 17, for men and 2.1, 0.53 to 8.5, for women). Those who took aspirin daily showed no increased risk of any other cancer, except colon cancer for both sexes combined (relative risk = 1.5, 1.1 to 2.2). The risk of acute myocardial infarction was reduced slightly among regular users of aspirin in men but not women. The risk of ischaemic heart disease was almost doubled

1989 BMJ : British Medical Journal PubMed abstract

7620. The effect of perioperative aspirin therapy in peripheral vascular surgery: a decision analysis. (Abstract)

The effect of perioperative aspirin therapy in peripheral vascular surgery: a decision analysis. Patients who undergo infrainguinal revascularization surgery are at increased risk for perioperative thrombotic complications. Aspirin decreases thrombotic events in the nonoperative setting; however, aspirin is often discontinued to avoid perioperative hemorrhagic complications. We used a decision analysis to determine whether aspirin should be discontinued before infrainguinal revascularization (...) surgery. Two strategies were compared: aspirin cessation 2 wk before surgery and aspirin continuation throughout the perioperative period. Clinical events examined included myocardial infarction, thrombotic cerebrovascular accident, hemorrhagic cerebrovascular accident, gastrointestinal hemorrhage, and incisional hemorrhagic complications. Event rates and effect of aspirin were obtained by using MEDLINE. The outcomes were perioperative mortality, life expectancy, and quality-adjusted life expectancy

2001 Anesthesia and analgesia

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