Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2016; 8(7): 501-507
Published online Jul 27, 2016. doi: 10.4240/wjgs.v8.i7.501
Aspirin use for primary prophylaxis: Adverse outcomes in non-variceal upper gastrointestinal bleeding
Karina M Souk, Hani M Tamim, Hussein A Abu Daya, Don C Rockey, Kassem A Barada
Karina M Souk, Hani M Tamim, Department of Internal Medicine, American University of Beirut-Medical Center, Beirut 11072020, Lebanon
Hani M Tamim, Biostatistics Support Unit, Clinical Research Institute, American University of Beirut-Medical Center, Beirut 11072020, Lebanon
Hussein A Abu Daya, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Don C Rockey, Department of Internal Medicine, the Medical University of South Carolina, Charleston, SC 29425, United States
Kassem A Barada, Division of Gastroenterology and Hepatology, American University of Beirut-Medical Center, Beirut 11072020, Lebanon
Author contributions: All authors contributed to this manuscript.
Institutional review board statement: AUBMC, IRB ID: IM.KB.09.
Informed consent statement: The IRB gave the approval to this study, and at that time they didn’t ask for informed consent because it was a retrospective study.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author, Dr. Kassem A Barada at kb02@aub.edu.lb.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kassem A Barada, MD, Division of Gastroenterology and Hepatology, American University of Beirut-Medical Center, P.O. Box 11-0236 Riad El Solh, Beirut 11072020, Lebanon. kb02@aub.edu.lb
Telephone: +961-3-780909 Fax: +961-1-370814
Received: March 3, 2016
Peer-review started: March 4, 2016
First decision: April 6, 2016
Revised: April 21, 2016
Accepted: May 10, 2016
Article in press: May 11, 2016
Published online: July 27, 2016
Processing time: 130 Days and 18.3 Hours
Abstract

AIM: To compare outcomes of patients with non-variceal upper gastrointestinal bleeding (NVUGIB) taking aspirin for primary prophylaxis to those not taking it.

METHODS: Patients not known to have any vascular disease (coronary artery or cerebrovascular disease) who were admitted to the American University of Beirut Medical Center between 1993 and 2010 with NVUGIB were included. The frequencies of in-hospital mortality, re-bleeding, severe bleeding, need for surgery or embolization, and of a composite outcome defined as the occurrence of any of the 4 bleeding related adverse outcomes were compared between patients receiving aspirin and those on no antithrombotics. We also compared frequency of in hospital complications and length of hospital stay between the two groups.

RESULTS: Of 357 eligible patients, 94 were on aspirin and 263 patients were on no antithrombotics (control group). Patients in the aspirin group were older, the mean age was 58 years in controls and 67 years in the aspirin group (P < 0.001). Patients in the aspirin group had significantly more co-morbidities, including diabetes mellitus and hypertension [25 (27%) vs 31 (112%) and 44 (47%) vs 74 (28%) respectively, (P = 0.001)], as well as dyslipidemia [21 (22%) vs 16 (6%), P < 0.0001). Smoking was more frequent in the aspirin group [34 (41%) vs 60 (27%), P = 0.02)]. The frequencies of endoscopic therapy and surgery were similar in both groups. Patients who were on aspirin had lower in-hospital mortality rates (2.1% vs 13.7%, P = 0.002), shorter hospital stay (4.9 d vs 7 d, P = 0.01), and fewer composite outcomes (10.6% vs 24%, P = 0.01). The frequencies of in-hospital complications and re-bleeding were similar in the two groups.

CONCLUSION: Patients who present with NVUGIB while receiving aspirin for primary prophylaxis had fewer adverse outcomes. Thus aspirin may have a protective effect beyond its cardiovascular benefits.

Keywords: Aspirin; Morbidity; Mortality; Non-variceal upper gastrointestinal bleeding; Outcomes

Core tip: Aspirin is known to increase the risk of upper gastrointestinal bleeding (UGIB), and it is customary to stop aspirin in patients presenting with gastrointestinal bleeding. Some studies have shown that being on aspirin is associated with better outcome in those patients. Our study compared clinical outcomes in patients who presented with non-variceal UGIB while taking aspirin for primary prophylaxis only to those of patients not taking aspirin. We found that patients taking aspirin had lower mortality and shorter hospital stay than patients not taking aspirin.