Key result
Aspirin continuation linked to ~58% higher MACE risk vs discontinuation in secondary prevention ulcer patients.
Why the study?
The appropriateness of continuing antiplatelet therapy in older hypertensive aspirin users with documented peptic ulcer disease was uncertain.
Does aspirin continuation or switching to clopidogrel affect the risk of incident MACEs or hospitalizations for UGIB compared to aspirin discontinuation in older hypertensive adults with peptic ulcer disease?
Cohort (n=735)
Yes
Does aspirin continuation or switching to clopidogrel affect the risk of incident MACEs or hospitalizations for UGIB compared to aspirin discontinuation in older hypertensive adults with peptic ulcer disease?
Continuing aspirin after a peptic ulcer disease diagnosis in older hypertensive adults may paradoxically increase the risk of MACEs in secondary prevention patients without significantly affecting UGIB hospitalization risk.
Should not yet change aspirin practice in secondary prevention after peptic ulcer; leaves open optimal strategy pending randomized confirmation.
Background The appropriateness of continuation of antiplatelet therapy in older hypertensive aspirin users with documented peptic ulcer disease (PUD) is uncertain. Methods This multicenter cohort study screened adults aged 65 years or older, using aspirin for primary and secondary cardiovascular disease prevention between January 2014 and December 2018. Patients with panendoscopy-proven PUD and hypertension were identified. Subsequent antiplatelet strategies were categorized as aspirin discontinuation (AD), aspirin continuation (AC), and switch to clopidogrel (SC) groups. Inverse probability of treatment weighting was applied to balance baseline characteristics. The main outcomes were incident major adverse cardiac events (MACEs) and hospitalizations for upper gastrointestinal bleeding (UGIB), followed through 31 December 2020. Results 735 eligible patients were analyzed. During a median follow-up of 39.7 months, 178 MACEs occurred. Compared with AD, SC was not related to the risk of incident MACEs, but AC increased the risk of incident MACEs (adjusted HR, 1.58; 95% CI, 1.04-2.38) in secondary prevention patients. On the other hand, 102 hospitalizations for UGIB occurred during a median follow-up of 43.4 months. Compared with AD, neither AC nor SC affected the risk of hospitalization for UGIB in secondary prevention patients. However, secondary prevention patients with chronic kidney disease were at increased risk of hospitalizations for UGIB (adjusted HR, 2.41; 95% CI, 1.30-4.47). Conclusions AC may increase the risk of incident MACEs in older hypertensive adults with PUD previously taking aspirin for secondary cardiovascular disease prevention. The appropriateness of antiplatelet therapy continuation after PUD is diagnosed in older hypertensive adults warrants rigorous considerations.
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Lan et al. (2023) conducted a cohort in Hypertension and Peptic Ulcer Disease (n=735). Aspirin continuation vs. Aspirin discontinuation was evaluated on Incident major adverse cardiac events (MACEs) in secondary prevention patients (HR 1.58, 95% CI 1.04-2.38). Aspirin continuation increased the risk of incident MACEs (HR 1.58) compared to discontinuation in older hypertensive adults with peptic ulcer disease previously on aspirin for secondary prevention.
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