Low‐dose acetylsalicylic acid and gastrointestinal ulcers or bleeding – a cohort study of the effects of proton pump inhibitor use patterns
Key result
Intermittent PPI use in patients on low-dose aspirin increased the risk of gastrointestinal ulcers or bleeding compared with continuous high-adherence PPI use (HR 1.83; 95% CI 1.66-2.02).
Why the study?
Does intermittent PPI use compared to continuous PPI use increase the risk of gastrointestinal ulcers or bleeding in patients on low-dose acetylsalicylic acid?
Population
648,807 Swedish residents ≥ 40 years of age, without cancer, receiving low-dose acetylsalicylic acid treatment
Comparison
Intermittent proton pump inhibitor use or no PPI… vs Continuous PPI use with high adherence (≥ 80%)
Design
Cohort
Follow-up
median 2.5 years
Authors
Discussion
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Implication
Intermittent PPI use may raise GI event risk during LDA therapy; leaves open need for RCTs to guide continuous prophylaxis.
Study Design
Type
Cohort (n=648,807)
Multicenter
Yes
Structured PICO
Does intermittent PPI use compared to continuous PPI use increase the risk of gastrointestinal ulcers or bleeding in patients on low-dose acetylsalicylic acid?
P
Population
648,807 Swedish residents aged ≥ 40 years without cancer receiving low-dose acetylsalicylic acid, followed for a median of 2.5 years.
E
Exposure
Intermittent proton pump inhibitor (PPI) use or no PPI use
C
Comparator
Continuous PPI use with high adherence (≥ 80%)
O
Outcome
Combined end-point of gastrointestinal ulcer or bleedingsafety
Main Result
Hazard Ratio: 1.83 (95% CI 1.66–2.02)
In patients on low-dose aspirin, intermittent PPI use is associated with a higher risk of gastrointestinal ulcers or bleeding and aspirin interruption compared to continuous, highly adherent PPI use.
Cite This Study
Hedberg et al. (2013) conducted a cohort in Patients treated with low-dose acetylsalicylic acid (LDA) (n=648,807). Intermittent proton pump inhibitor (PPI) use vs. Continuous PPI use with a high level of adherence was evaluated on Combined end-point of gastrointestinal ulcer or bleeding (HR 1.83, 95% CI 1.66-2.02). Intermittent PPI use in patients on low-dose aspirin increased the risk of gastrointestinal ulcers or bleeding compared with continuous high-adherence PPI use (HR 1.83; 95% CI 1.66-2.02).