The risk of lower gastrointestinal bleeding in low‐dose aspirin users
Summary Background Aspirin increases the risk of gastrointestinal bleeding. Aim To investigate the risk of lower gastrointestinal bleeding (LGIB) in aspirin users. Methods Low‐dose (75‐325 mg daily) aspirin users and controls matched by age, gender and enrollment time in a 1:5 ratio were selected fr...
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| Veröffentlicht in: | Alimentary pharmacology & therapeutics 2017-06, Vol.45 (12), p.1542-1550 |
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| creator | Chen, W.‐C. Lin, K.‐H. Huang, Y.‐T. Tsai, T.‐J. Sun, W.‐C. Chuah, S.‐K. Wu, D.‐C. Hsu, P.‐I. |
| description | Summary
Background
Aspirin increases the risk of gastrointestinal bleeding.
Aim
To investigate the risk of lower gastrointestinal bleeding (LGIB) in aspirin users.
Methods
Low‐dose (75‐325 mg daily) aspirin users and controls matched by age, gender and enrollment time in a 1:5 ratio were selected from 1 million randomly sampled subjects in the National Health Insurance Research Database of Taiwan. Cox proportional hazard regression models were developed to evaluate the predictors of LGIB with adjustments for age, gender, comorbidities including coronary artery disease, ischaemic stroke, diabetes, hypertension, chronic kidney disease, liver cirrhosis, chronic obstructive pulmonary disease, dyslipidemia, uncomplicated peptic ulcer disease, history of peptic ulcer bleeding, and concomitant use of clopidogrel, ticlopidine, warfarin, nonsteroidal anti‐inflammatory drugs (NSAIDs), cyclooxygenase‐2 inhibitors, steroids, proton pump inhibitors (PPIs), histamine‐2 receptor antagonists (H2RAs), nitrates, alendronate, selective serotonin reuptake inhibitors (SSRIs) and calcium channel blockers.
Results
A total of 53 805 aspirin users and 269 025 controls were included. Aspirin group had a higher incidence of LGIB within 1 year than control group (0.20% vs 0.06%, P |
| doi_str_mv | 10.1111/apt.14079 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_1922444206</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1922444206</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4219-c9fd1b53dad307b7620c331c2d86e79e423c08102880bd6ae7cf6a8db0bc94ff3</originalsourceid><addsrcrecordid>eNp1kLtOwzAUQC0EoqUw8AMoEhNDWr_q2GNVQUGqBEOZLcd2ikuaBDtR1Y1P4Bv5ElwCbNzlSldHR1cHgEsExyjORDXtGFGYiSMwRIRNUwwJOwZDiJlIMUdkAM5C2EAIWQbxKRhgTqlAnA3BYvViE-_Ca1IXSVnvrE_WKrS-dlVrQ-sqVSZ5aa1x1Tpx1QH5fP8wdbCJCo3z8dQF68M5OClUGezFzx6B57vb1fw-XT4uHuazZaopRiLVojAonxKjDIFZnjEMNSFIY8OZzYSlmGjIEcScw9wwZTNdMMVNDnMtaFGQEbjuvY2v37r4odzUnY9fBokExpRSDFmkbnpK-zoEbwvZeLdVfi8RlIdkMiaT38kie_Vj7PKtNX_kb6MITHpg50q7_98kZ0-rXvkFh9x2YA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1922444206</pqid></control><display><type>article</type><title>The risk of lower gastrointestinal bleeding in low‐dose aspirin users</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Wiley Online Library Free Content</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Chen, W.‐C. ; Lin, K.‐H. ; Huang, Y.‐T. ; Tsai, T.‐J. ; Sun, W.‐C. ; Chuah, S.‐K. ; Wu, D.‐C. ; Hsu, P.‐I.</creator><creatorcontrib>Chen, W.‐C. ; Lin, K.‐H. ; Huang, Y.‐T. ; Tsai, T.‐J. ; Sun, W.‐C. ; Chuah, S.‐K. ; Wu, D.‐C. ; Hsu, P.‐I.</creatorcontrib><description>Summary
Background
Aspirin increases the risk of gastrointestinal bleeding.
Aim
To investigate the risk of lower gastrointestinal bleeding (LGIB) in aspirin users.
Methods
Low‐dose (75‐325 mg daily) aspirin users and controls matched by age, gender and enrollment time in a 1:5 ratio were selected from 1 million randomly sampled subjects in the National Health Insurance Research Database of Taiwan. Cox proportional hazard regression models were developed to evaluate the predictors of LGIB with adjustments for age, gender, comorbidities including coronary artery disease, ischaemic stroke, diabetes, hypertension, chronic kidney disease, liver cirrhosis, chronic obstructive pulmonary disease, dyslipidemia, uncomplicated peptic ulcer disease, history of peptic ulcer bleeding, and concomitant use of clopidogrel, ticlopidine, warfarin, nonsteroidal anti‐inflammatory drugs (NSAIDs), cyclooxygenase‐2 inhibitors, steroids, proton pump inhibitors (PPIs), histamine‐2 receptor antagonists (H2RAs), nitrates, alendronate, selective serotonin reuptake inhibitors (SSRIs) and calcium channel blockers.
Results
A total of 53 805 aspirin users and 269 025 controls were included. Aspirin group had a higher incidence of LGIB within 1 year than control group (0.20% vs 0.06%, P<.0001). Aspirin (hazard ratio [HR]: 2.75, 95% confidence interval [CI]: 2.06‐3.65), NSAIDs (HR: 8.61, 95% CI: 3.28‐22.58), steroids (HR: 10.50, 95% CI: 1.98‐55.57), SSRIs (HR: 11.71, 95% CI: 1.40‐97.94), PPIs (HR: 8.47, 95% CI: 2.26‐31.71), and H2RAs (HR: 10.83, 95% CI: 2.98‐39.33) were significantly associated with LGIB.
Conclusions
The risk of LGIB was higher in low‐dose aspirin users than in aspirin nonusers in this nationwide cohort. Low‐dose aspirin, NSAIDs, steroids, SSRIs, PPIs and H2RAs were independent risk factors for LGIB.
Linked ContentThis article is linked to Taha and Chen et al papers. To view these articles visit https://doi.org/10.1111/apt.14114 and https://doi.org/10.1111/apt.14138.</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>DOI: 10.1111/apt.14079</identifier><identifier>PMID: 28449186</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Alendronic acid ; Anti-inflammatory agents ; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use ; Aspirin ; Aspirin - administration & dosage ; Aspirin - adverse effects ; Bisphosphonates ; Bleeding ; Calcium ; Cardiovascular disease ; Case-Control Studies ; Chronic obstructive pulmonary disease ; Cirrhosis ; Clopidogrel ; Comorbidity ; Coronary artery ; Coronary artery disease ; COX-2 inhibitors ; Cyclooxygenase 2 Inhibitors - therapeutic use ; Cyclooxygenase-2 ; Databases, Factual ; Diabetes mellitus ; Dose-Response Relationship, Drug ; Dyslipidemia ; Female ; Gastrointestinal Hemorrhage - chemically induced ; Gastrointestinal Hemorrhage - epidemiology ; Gastrointestinal Hemorrhage - etiology ; Health risk assessment ; Heart diseases ; Hemorrhage ; Histamine ; Histamine H2 Antagonists - therapeutic use ; Humans ; Incidence ; Inflammation ; Inhibitors ; Liver ; Liver cirrhosis ; Liver diseases ; Lung diseases ; Male ; Middle Aged ; Nonsteroidal anti-inflammatory drugs ; Obstructive lung disease ; Peptic Ulcer - complications ; Peptic Ulcer - drug therapy ; Peptic Ulcer - epidemiology ; Peptic Ulcer Hemorrhage - drug therapy ; Peptic Ulcer Hemorrhage - epidemiology ; Proton pump inhibitors ; Proton Pump Inhibitors - therapeutic use ; Regression analysis ; Renal Insufficiency, Chronic - complications ; Renal Insufficiency, Chronic - drug therapy ; Renal Insufficiency, Chronic - epidemiology ; Risk Factors ; Serotonin ; Serotonin uptake inhibitors ; Serotonin Uptake Inhibitors - therapeutic use ; Steroid hormones ; Steroids ; Stroke ; Taiwan - epidemiology ; Ticlopidine - analogs & derivatives ; Ticlopidine - therapeutic use ; Ulcers ; Warfarin ; Warfarin - therapeutic use ; Young Adult</subject><ispartof>Alimentary pharmacology & therapeutics, 2017-06, Vol.45 (12), p.1542-1550</ispartof><rights>2017 John Wiley & Sons Ltd</rights><rights>2017 John Wiley & Sons Ltd.</rights><rights>Copyright © 2017 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4219-c9fd1b53dad307b7620c331c2d86e79e423c08102880bd6ae7cf6a8db0bc94ff3</citedby><cites>FETCH-LOGICAL-c4219-c9fd1b53dad307b7620c331c2d86e79e423c08102880bd6ae7cf6a8db0bc94ff3</cites><orcidid>0000-0002-7572-4201</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fapt.14079$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fapt.14079$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28449186$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chen, W.‐C.</creatorcontrib><creatorcontrib>Lin, K.‐H.</creatorcontrib><creatorcontrib>Huang, Y.‐T.</creatorcontrib><creatorcontrib>Tsai, T.‐J.</creatorcontrib><creatorcontrib>Sun, W.‐C.</creatorcontrib><creatorcontrib>Chuah, S.‐K.</creatorcontrib><creatorcontrib>Wu, D.‐C.</creatorcontrib><creatorcontrib>Hsu, P.‐I.</creatorcontrib><title>The risk of lower gastrointestinal bleeding in low‐dose aspirin users</title><title>Alimentary pharmacology & therapeutics</title><addtitle>Aliment Pharmacol Ther</addtitle><description>Summary
Background
Aspirin increases the risk of gastrointestinal bleeding.
Aim
To investigate the risk of lower gastrointestinal bleeding (LGIB) in aspirin users.
Methods
Low‐dose (75‐325 mg daily) aspirin users and controls matched by age, gender and enrollment time in a 1:5 ratio were selected from 1 million randomly sampled subjects in the National Health Insurance Research Database of Taiwan. Cox proportional hazard regression models were developed to evaluate the predictors of LGIB with adjustments for age, gender, comorbidities including coronary artery disease, ischaemic stroke, diabetes, hypertension, chronic kidney disease, liver cirrhosis, chronic obstructive pulmonary disease, dyslipidemia, uncomplicated peptic ulcer disease, history of peptic ulcer bleeding, and concomitant use of clopidogrel, ticlopidine, warfarin, nonsteroidal anti‐inflammatory drugs (NSAIDs), cyclooxygenase‐2 inhibitors, steroids, proton pump inhibitors (PPIs), histamine‐2 receptor antagonists (H2RAs), nitrates, alendronate, selective serotonin reuptake inhibitors (SSRIs) and calcium channel blockers.
Results
A total of 53 805 aspirin users and 269 025 controls were included. Aspirin group had a higher incidence of LGIB within 1 year than control group (0.20% vs 0.06%, P<.0001). Aspirin (hazard ratio [HR]: 2.75, 95% confidence interval [CI]: 2.06‐3.65), NSAIDs (HR: 8.61, 95% CI: 3.28‐22.58), steroids (HR: 10.50, 95% CI: 1.98‐55.57), SSRIs (HR: 11.71, 95% CI: 1.40‐97.94), PPIs (HR: 8.47, 95% CI: 2.26‐31.71), and H2RAs (HR: 10.83, 95% CI: 2.98‐39.33) were significantly associated with LGIB.
Conclusions
The risk of LGIB was higher in low‐dose aspirin users than in aspirin nonusers in this nationwide cohort. Low‐dose aspirin, NSAIDs, steroids, SSRIs, PPIs and H2RAs were independent risk factors for LGIB.
Linked ContentThis article is linked to Taha and Chen et al papers. To view these articles visit https://doi.org/10.1111/apt.14114 and https://doi.org/10.1111/apt.14138.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Alendronic acid</subject><subject>Anti-inflammatory agents</subject><subject>Anti-Inflammatory Agents, Non-Steroidal - therapeutic use</subject><subject>Aspirin</subject><subject>Aspirin - administration & dosage</subject><subject>Aspirin - adverse effects</subject><subject>Bisphosphonates</subject><subject>Bleeding</subject><subject>Calcium</subject><subject>Cardiovascular disease</subject><subject>Case-Control Studies</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Cirrhosis</subject><subject>Clopidogrel</subject><subject>Comorbidity</subject><subject>Coronary artery</subject><subject>Coronary artery disease</subject><subject>COX-2 inhibitors</subject><subject>Cyclooxygenase 2 Inhibitors - therapeutic use</subject><subject>Cyclooxygenase-2</subject><subject>Databases, Factual</subject><subject>Diabetes mellitus</subject><subject>Dose-Response Relationship, Drug</subject><subject>Dyslipidemia</subject><subject>Female</subject><subject>Gastrointestinal Hemorrhage - chemically induced</subject><subject>Gastrointestinal Hemorrhage - epidemiology</subject><subject>Gastrointestinal Hemorrhage - etiology</subject><subject>Health risk assessment</subject><subject>Heart diseases</subject><subject>Hemorrhage</subject><subject>Histamine</subject><subject>Histamine H2 Antagonists - therapeutic use</subject><subject>Humans</subject><subject>Incidence</subject><subject>Inflammation</subject><subject>Inhibitors</subject><subject>Liver</subject><subject>Liver cirrhosis</subject><subject>Liver diseases</subject><subject>Lung diseases</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nonsteroidal anti-inflammatory drugs</subject><subject>Obstructive lung disease</subject><subject>Peptic Ulcer - complications</subject><subject>Peptic Ulcer - drug therapy</subject><subject>Peptic Ulcer - epidemiology</subject><subject>Peptic Ulcer Hemorrhage - drug therapy</subject><subject>Peptic Ulcer Hemorrhage - epidemiology</subject><subject>Proton pump inhibitors</subject><subject>Proton Pump Inhibitors - therapeutic use</subject><subject>Regression analysis</subject><subject>Renal Insufficiency, Chronic - complications</subject><subject>Renal Insufficiency, Chronic - drug therapy</subject><subject>Renal Insufficiency, Chronic - epidemiology</subject><subject>Risk Factors</subject><subject>Serotonin</subject><subject>Serotonin uptake inhibitors</subject><subject>Serotonin Uptake Inhibitors - therapeutic use</subject><subject>Steroid hormones</subject><subject>Steroids</subject><subject>Stroke</subject><subject>Taiwan - epidemiology</subject><subject>Ticlopidine - analogs & derivatives</subject><subject>Ticlopidine - therapeutic use</subject><subject>Ulcers</subject><subject>Warfarin</subject><subject>Warfarin - therapeutic use</subject><subject>Young Adult</subject><issn>0269-2813</issn><issn>1365-2036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kLtOwzAUQC0EoqUw8AMoEhNDWr_q2GNVQUGqBEOZLcd2ikuaBDtR1Y1P4Bv5ElwCbNzlSldHR1cHgEsExyjORDXtGFGYiSMwRIRNUwwJOwZDiJlIMUdkAM5C2EAIWQbxKRhgTqlAnA3BYvViE-_Ca1IXSVnvrE_WKrS-dlVrQ-sqVSZ5aa1x1Tpx1QH5fP8wdbCJCo3z8dQF68M5OClUGezFzx6B57vb1fw-XT4uHuazZaopRiLVojAonxKjDIFZnjEMNSFIY8OZzYSlmGjIEcScw9wwZTNdMMVNDnMtaFGQEbjuvY2v37r4odzUnY9fBokExpRSDFmkbnpK-zoEbwvZeLdVfi8RlIdkMiaT38kie_Vj7PKtNX_kb6MITHpg50q7_98kZ0-rXvkFh9x2YA</recordid><startdate>201706</startdate><enddate>201706</enddate><creator>Chen, W.‐C.</creator><creator>Lin, K.‐H.</creator><creator>Huang, Y.‐T.</creator><creator>Tsai, T.‐J.</creator><creator>Sun, W.‐C.</creator><creator>Chuah, S.‐K.</creator><creator>Wu, D.‐C.</creator><creator>Hsu, P.‐I.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>M7N</scope><orcidid>https://orcid.org/0000-0002-7572-4201</orcidid></search><sort><creationdate>201706</creationdate><title>The risk of lower gastrointestinal bleeding in low‐dose aspirin users</title><author>Chen, W.‐C. ; Lin, K.‐H. ; Huang, Y.‐T. ; Tsai, T.‐J. ; Sun, W.‐C. ; Chuah, S.‐K. ; Wu, D.‐C. ; Hsu, P.‐I.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4219-c9fd1b53dad307b7620c331c2d86e79e423c08102880bd6ae7cf6a8db0bc94ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Alendronic acid</topic><topic>Anti-inflammatory agents</topic><topic>Anti-Inflammatory Agents, Non-Steroidal - therapeutic use</topic><topic>Aspirin</topic><topic>Aspirin - administration & dosage</topic><topic>Aspirin - adverse effects</topic><topic>Bisphosphonates</topic><topic>Bleeding</topic><topic>Calcium</topic><topic>Cardiovascular disease</topic><topic>Case-Control Studies</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Cirrhosis</topic><topic>Clopidogrel</topic><topic>Comorbidity</topic><topic>Coronary artery</topic><topic>Coronary artery disease</topic><topic>COX-2 inhibitors</topic><topic>Cyclooxygenase 2 Inhibitors - therapeutic use</topic><topic>Cyclooxygenase-2</topic><topic>Databases, Factual</topic><topic>Diabetes mellitus</topic><topic>Dose-Response Relationship, Drug</topic><topic>Dyslipidemia</topic><topic>Female</topic><topic>Gastrointestinal Hemorrhage - chemically induced</topic><topic>Gastrointestinal Hemorrhage - epidemiology</topic><topic>Gastrointestinal Hemorrhage - etiology</topic><topic>Health risk assessment</topic><topic>Heart diseases</topic><topic>Hemorrhage</topic><topic>Histamine</topic><topic>Histamine H2 Antagonists - therapeutic use</topic><topic>Humans</topic><topic>Incidence</topic><topic>Inflammation</topic><topic>Inhibitors</topic><topic>Liver</topic><topic>Liver cirrhosis</topic><topic>Liver diseases</topic><topic>Lung diseases</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nonsteroidal anti-inflammatory drugs</topic><topic>Obstructive lung disease</topic><topic>Peptic Ulcer - complications</topic><topic>Peptic Ulcer - drug therapy</topic><topic>Peptic Ulcer - epidemiology</topic><topic>Peptic Ulcer Hemorrhage - drug therapy</topic><topic>Peptic Ulcer Hemorrhage - epidemiology</topic><topic>Proton pump inhibitors</topic><topic>Proton Pump Inhibitors - therapeutic use</topic><topic>Regression analysis</topic><topic>Renal Insufficiency, Chronic - complications</topic><topic>Renal Insufficiency, Chronic - drug therapy</topic><topic>Renal Insufficiency, Chronic - epidemiology</topic><topic>Risk Factors</topic><topic>Serotonin</topic><topic>Serotonin uptake inhibitors</topic><topic>Serotonin Uptake Inhibitors - therapeutic use</topic><topic>Steroid hormones</topic><topic>Steroids</topic><topic>Stroke</topic><topic>Taiwan - epidemiology</topic><topic>Ticlopidine - analogs & derivatives</topic><topic>Ticlopidine - therapeutic use</topic><topic>Ulcers</topic><topic>Warfarin</topic><topic>Warfarin - therapeutic use</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, W.‐C.</creatorcontrib><creatorcontrib>Lin, K.‐H.</creatorcontrib><creatorcontrib>Huang, Y.‐T.</creatorcontrib><creatorcontrib>Tsai, T.‐J.</creatorcontrib><creatorcontrib>Sun, W.‐C.</creatorcontrib><creatorcontrib>Chuah, S.‐K.</creatorcontrib><creatorcontrib>Wu, D.‐C.</creatorcontrib><creatorcontrib>Hsu, P.‐I.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><jtitle>Alimentary pharmacology & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chen, W.‐C.</au><au>Lin, K.‐H.</au><au>Huang, Y.‐T.</au><au>Tsai, T.‐J.</au><au>Sun, W.‐C.</au><au>Chuah, S.‐K.</au><au>Wu, D.‐C.</au><au>Hsu, P.‐I.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The risk of lower gastrointestinal bleeding in low‐dose aspirin users</atitle><jtitle>Alimentary pharmacology & therapeutics</jtitle><addtitle>Aliment Pharmacol Ther</addtitle><date>2017-06</date><risdate>2017</risdate><volume>45</volume><issue>12</issue><spage>1542</spage><epage>1550</epage><pages>1542-1550</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><abstract>Summary
Background
Aspirin increases the risk of gastrointestinal bleeding.
Aim
To investigate the risk of lower gastrointestinal bleeding (LGIB) in aspirin users.
Methods
Low‐dose (75‐325 mg daily) aspirin users and controls matched by age, gender and enrollment time in a 1:5 ratio were selected from 1 million randomly sampled subjects in the National Health Insurance Research Database of Taiwan. Cox proportional hazard regression models were developed to evaluate the predictors of LGIB with adjustments for age, gender, comorbidities including coronary artery disease, ischaemic stroke, diabetes, hypertension, chronic kidney disease, liver cirrhosis, chronic obstructive pulmonary disease, dyslipidemia, uncomplicated peptic ulcer disease, history of peptic ulcer bleeding, and concomitant use of clopidogrel, ticlopidine, warfarin, nonsteroidal anti‐inflammatory drugs (NSAIDs), cyclooxygenase‐2 inhibitors, steroids, proton pump inhibitors (PPIs), histamine‐2 receptor antagonists (H2RAs), nitrates, alendronate, selective serotonin reuptake inhibitors (SSRIs) and calcium channel blockers.
Results
A total of 53 805 aspirin users and 269 025 controls were included. Aspirin group had a higher incidence of LGIB within 1 year than control group (0.20% vs 0.06%, P<.0001). Aspirin (hazard ratio [HR]: 2.75, 95% confidence interval [CI]: 2.06‐3.65), NSAIDs (HR: 8.61, 95% CI: 3.28‐22.58), steroids (HR: 10.50, 95% CI: 1.98‐55.57), SSRIs (HR: 11.71, 95% CI: 1.40‐97.94), PPIs (HR: 8.47, 95% CI: 2.26‐31.71), and H2RAs (HR: 10.83, 95% CI: 2.98‐39.33) were significantly associated with LGIB.
Conclusions
The risk of LGIB was higher in low‐dose aspirin users than in aspirin nonusers in this nationwide cohort. Low‐dose aspirin, NSAIDs, steroids, SSRIs, PPIs and H2RAs were independent risk factors for LGIB.
Linked ContentThis article is linked to Taha and Chen et al papers. To view these articles visit https://doi.org/10.1111/apt.14114 and https://doi.org/10.1111/apt.14138.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28449186</pmid><doi>10.1111/apt.14079</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-7572-4201</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Alimentary pharmacology & therapeutics, 2017-06, Vol.45 (12), p.1542-1550 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Wiley Online Library Free Content; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult Aged Aged, 80 and over Alendronic acid Anti-inflammatory agents Anti-Inflammatory Agents, Non-Steroidal - therapeutic use Aspirin Aspirin - administration & dosage Aspirin - adverse effects Bisphosphonates Bleeding Calcium Cardiovascular disease Case-Control Studies Chronic obstructive pulmonary disease Cirrhosis Clopidogrel Comorbidity Coronary artery Coronary artery disease COX-2 inhibitors Cyclooxygenase 2 Inhibitors - therapeutic use Cyclooxygenase-2 Databases, Factual Diabetes mellitus Dose-Response Relationship, Drug Dyslipidemia Female Gastrointestinal Hemorrhage - chemically induced Gastrointestinal Hemorrhage - epidemiology Gastrointestinal Hemorrhage - etiology Health risk assessment Heart diseases Hemorrhage Histamine Histamine H2 Antagonists - therapeutic use Humans Incidence Inflammation Inhibitors Liver Liver cirrhosis Liver diseases Lung diseases Male Middle Aged Nonsteroidal anti-inflammatory drugs Obstructive lung disease Peptic Ulcer - complications Peptic Ulcer - drug therapy Peptic Ulcer - epidemiology Peptic Ulcer Hemorrhage - drug therapy Peptic Ulcer Hemorrhage - epidemiology Proton pump inhibitors Proton Pump Inhibitors - therapeutic use Regression analysis Renal Insufficiency, Chronic - complications Renal Insufficiency, Chronic - drug therapy Renal Insufficiency, Chronic - epidemiology Risk Factors Serotonin Serotonin uptake inhibitors Serotonin Uptake Inhibitors - therapeutic use Steroid hormones Steroids Stroke Taiwan - epidemiology Ticlopidine - analogs & derivatives Ticlopidine - therapeutic use Ulcers Warfarin Warfarin - therapeutic use Young Adult |
| title | The risk of lower gastrointestinal bleeding in low‐dose aspirin users |
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