Published online Jul 27, 2016. doi: 10.4240/wjgs.v8.i7.501
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
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.
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.