Low doses of aspirin and gastrointestinal complications (Literature review)


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Abstract

Low-dose aspirin has been and remains one of the main antithrombotic agents used to prevent cardiovascular accidents. However, its use is associated with a wide range of complications from the gastrointestinal tract, including such a dangerous pathology, as ulcers and bleeding. According to statistics, while receiving low doses of aspirin, dyspepsia occurs in 30, gastric erosion in more than 50, gastric and duodenal ulcers in about 7, and «large» gastrointestinal bleeding in 0.6% of patients. In the presented review, the pathogenesis of these complications, their clinical and endoscopic characteristics, epidemiology and risk factors, including the role of Helicobacter pylori, are considered. Low-dose aspirin and H. pylori have been shown to be independent factors for ulcers and gastrointestinal bleeding. The advantages and disadvantages of the main methods of preventing side effects while taking low doses of aspirin are discussed: the use of proton pump inhibitors, anti-helicobacter therapy, the use of rebamipide. When prescribing aspirin as an antithrombotic agent, one should be aware of the danger of development in patients with risk factors for life-threatening bleeding and the need for their prevention.

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References

  1. Каратеев А.Е., Насонов Е.Л. Профилактика сосудистых тромбозов и риск развития желудочно-кишечных осложнений // Тер. архив. - 2007. - Т. 79, № 5. - С. 84-89.
  2. Мороз Е.В., Каратеев А.Е. Ребамипид: эффективная медикаментозная профилактика НПВП-энтеропатии возможна // Совр. ревматология. - 2016 - Т.10, № 4. - С. 97-105.
  3. Andreotti F., Testa L., Biondi-Zoccai G., Crea F. Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes: an updated and comprehensive meta-analysis of 25 307 patients // Press Med. - 2003. - N 32. - P. 9-16.
  4. Berger J., Roncaglioni M., Avanzini F. et al. Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials // JAMA. - 2006. - N 295. - P. 306-313.
  5. Chan F., Ching J., Suen B. et al. Effects of Helicobacter pylori infection on long-term risk of peptic ulcer bleeding in low-dose aspirin users // Gastroenterology. - 2013. - Vol. 144, N 3. - P. 528-35.
  6. Chan F., Ching J., Hung L. et al. Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding // N. Engl. J. Med. - 2005. - N 352. - P. 238-244.
  7. Chan F., Sung J., Suen B. et al. Prospective randomized trial of H. pylori eradication versus maintenance omeprazole to prevent recurrent upper gastrointestinal hemorrhage in high-risk aspirin and nonaspirin NSAID users // Gastroenterology. - 2000. - N 118. - P. 194.
  8. Cryer B., Feldman M. Effect of very low dose daily long-term therapy on gastric, duodenal, and rectal prostaglandin levels and mucosal injury in healthy human // Gastroenterology. - 1999. - N 117. - P. 17-25.
  9. Derry S., Loke Y. Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis // BMJ. - 2002. - N 521. - P. 1183-1187.
  10. Fernаndez-Banares F., de Sousa M.R., Salas A. et al. Epidemiological risk factors in microscopic colitis: a prospective case-control study // Inflamm Bowel Dis. - 2013. - Vol. 19, N 2. - P. 411-7.
  11. Gu Q., Dillon C.F., Eberhardt M.S. et al. Preventive Aspirin and Other Antiplatelet Medication Use Among U.S. Adults Aged ? 40 Years: Data from the National Health and Nutrition Examination Survey, 2011-2012 // Public Health Rep. - 2015. - Vol. 130, N 6. - P. 643-54.
  12. Hsu P.I., Tsai T.J. Epidemiology of Upper Gastrointestinal Damage Associated with Low-Dose Aspirin // Cur. Pharm. Des. - 2015. - Vol. 21, N 35. - P. 5049-55.
  13. Hsiao F.Y., Tsai Y.W., Huang W.F. et al. A comparison of aspirin and clopidogrel with or without proton pump inhibitors for the secondary prevention of cardiovascular events in patients at high risk for gastrointestinal bleeding // Clin. Ther. - 2009. - Vol. 31, N 9. - P. 2038-47.
  14. Kharlamov A.N. Cardiovascular burden and percutaneous interventions in Russian Federation: systematic epidemiological update // Cardiovasc. Diagn. Ther. - 2017. - Vol. 7, N 1. - P. 60-84.
  15. Lai K., Lam S., Chu K. et al. Lansoprazole for the prevention of recurrences of ulcer complication from long-term low-dose aspirin use // N. Engl. J. Med. - 2002. - N 346. - 2033-2038.
  16. Lanas A., Garsia-Rodriguez L., Arroyo M. et al. Risk of upper gastrointestinal ulcer bleeding associated with selective COX-2 inhibitors, traditional non-steroidal non-aspirin NSAID, aspirin, and combinations // Gut. - 2006. - Vol. 55, N 12. - P. 1731-8.
  17. Malfertheiner P, Megraud F, O’Morain C.A. et al. Management of Helicobacter pylori infection: the Maastricht V / Florence Consensus Report // Gut. - 2017. - Vol. 66, N 1. - P. 6-30.
  18. Ng F., Wong S., Lam K. et al. Famotidine is inferior to pantoprazole in preventing recurrence of aspirin-related peptic ulcers or erosions // Gastroenterology. - 2010. - Vol. 138, N 1. - P. 82-88.
  19. Ng F., Tunggal P., Chu W. et al. Esomeprazole compared with famotidine in the prevention of upper gastrointestinal bleeding in patients with acute coronary syndrome or myocardial infarction // Am. J. Gastroenterol. - 2012. - Vol.107, N 3. - P. 389-396.
  20. Pavlidis P., Bjarnason I. Aspirin Induced Adverse Effects on the Small and Large Intestine // Curr. Pharm. Des. - 2015. - Vol. 21, N 35. - P. 5089-93.
  21. Rachme E., Bardon M., Dasgupta K. et al. Hospitalisation for gastrointestinal bleeding associated with non-steroidal anti-inflammatory drugs among elderly patients using low-dose aspirin: a retrospective cohort study // Rheumatology. - 2006. - Vol. 46, N 2. - P. 265-72.
  22. Scheiman J.M., Devereaux P.J., Herlitz J. et al. Prevention of peptic ulcers with esomeprazole in patients at risk of ulcer development treated with low-dose acetylsalicylic acid: a randomised, controlled trial (OBERON) // Heart. - 2011. - Vol. 97, N 10. - P. 797-802.
  23. Sibilia J., Pavaud P., Marck G. Risk factors for gastrointestinal bleeding associated with low-dose aspirin // Eur. Heart J. - 2006. - N 27. - P. 519-526.
  24. Silverstein F., Faich G., Goldstein J. et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis. The CLASS study: a randomized controlled trial // JAMA. - 2000. - N 284. - P. 1247-1255.
  25. Sorensen H., Mellemkjaer L., Blot W. Risk of upper gastrointestinal bleeding with use low-dose aspirin // Am. J. Gastroenterol. - 2000. - N 95. - P. 2218-2224.
  26. Sostres C, Lanas A. Epidemiology of Low Dose Aspirin Damage in the Lower Gastrointestinal Tract // Curr. Pharm. Des. - 2015. - Vol. 21, N 35. - P. 5094-100.
  27. Taha A., Angerson W., Knill-Jones R., Blatchford O. Upper gastrointestinal mucosal abnormalities and blood loss complication low-dose aspirin and antithrombotic therapy // Aliment. Pharmacol. Ther. - 2006. - N 23. - P. 489-495.
  28. Watanabe T., Takeuchi T., Handa O. et al. A multicenter, randomized, double-blind, placebo-controlled trial of high-dose rebamipide treatment for low-dose aspirin-induced moderate-to-severe small intestinal damage // PLoS One. - 2015. - Vol. 10, N 4. - e0122330.
  29. Weil J., Colin-Jones D., Langman M. et al. Prophylactic aspirin and risk of peptic ulcer bleeding // BMJ. - 1995. - N 310. - P. 827-830.

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Copyright (c) 2019 Moroz E.V., Chernetsov V.A., Kryukov E.V.


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: № 01975 от 30.12.1992.

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