Risk of upper gastrointestinal bleeding associated with use of low-dose aspirin

OBJECTIVE: Aspirin products are known to cause irritation and injury to the gastric mucosa. We examined the risk of hospitalization for upper gastroin testinal bleeding with use of low-dose aspirin. METHODS: This was a cohort study based on record linkage between a populati on-based prescription database and a hospital discharge registry in North J utland County, Denmark, from January 1, 1991, to December 31, 1995. Inciden ce rates of upper gastrointestinal bleeding in 27,694 users of low-dose asp irin were compared with the incidence rates in the general population in th e county. RESULTS: A total of 207 exclusive users of low-dose aspirin experienced a f irst episode of upper gastrointestinal bleeding with admission to the hospi tal during the study period. The standardized incidence rate ratio was 2.6 (95% confidence interval, 2.2-2.9), 2.3 in women and 2.8 in men. The standa rdized incidence rate ratio for combined use of low-dose aspirin and other nonsteroidal anti-inflammatory drugs was 5.6 (95% confidence interval, 4.4- 7.0). The risk was similar among users of noncoated low-dose aspirin (stand ardized incidence rate ratio, 2.6; 95% confidence interval, 1.8-3.5) and co ated low-dose aspirin (standardized incidence rate ratio, 2.6; 95% confiden ce interval, 2.2-3.0). CONCLUSIONS: Use of low-dose aspirin was associated with an increased risk of upper gastrointestinal bleeding, with still higher risks when combined w ith other nonsteroidal anti-inflammatory drugs. Enteric coating did not see m to reduce the risk. The findings from this observational study raise the possibility that prophylactic use of low-dose aspirin may convey an increas ed risk of gastrointestinal bleeding, which may offset some of its benefits . (Am J Gastroenterol 2000;95:2218-2224. (C) 2000 by Am. Cell. of Gastroent erology).