Cardioprotective effects and gastrointestinal risks of aspirin: Maintaining the delicate balance |
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| Affiliation: | 1. Division of Gastroenterology, University of Washington, School of Medicine, Seattle, Washington, USA;1. Department of Vascular Surgery, Botucatu School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil;2. Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY;1. Division of Urology, Albany Medical College, Albany, NY;2. Urological Institute of Northeastern New York, Albany, NY;3. Center for Neuropharmacology and Neuroscience, Albany Medical College, Albany, NY;1. The Department of Pediatric Surgery, Rigshospitalet, Copenhagen, Denmark;2. Faculty of Health Science, University of Copenhagen, Denmark;3. The Department of Pathology, Rigshospitalet, Copenhagen, Denmark;4. Section of Endocrinology, Department of Pediatrics, Hvidovre Hospital, Copenhagen, Denmark;1. Department of Urology, Children''s Hospital of Chongqing Medical University, Chongqing, China;2. Chongqing Key Laboratory of Children''s Urogenital Development and Tissue Engineering, China;3. Ministry of Education Key Laboratory of Child Development and Disorders, China;4. China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China;5. Chongqing Key Laboratory of Pediatrics Chongqing, China;1. Division of Urology, Duke Cancer Institute, Durham, NC;2. Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran;3. Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, NC;4. Department of Urology, Oregon Health & Science University, Portland, OR;5. Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA;6. Departments of Urology and Epidemiology & Biostatistics, University of California, San Francisco, CA;7. Department of Urology, University of California at San Diego Medical Center, San Diego, CA;8. Urology Section, Department of Surgery, Veterans Affairs Medical Centers and Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA;9. Division of Urology and Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA |
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| Abstract: | Aspirin is a very useful medication for the prevention of cardiovascular thrombotic events in patients with or those at risk for cardiovascular disease (CVD). Aspirin, however, carries an increased risk for gastrointestinal (GI) injury (e.g., ulceration) and its complications (e.g., hemorrhage), which may be caused by its antiplatelet and gastric mucosal effects. In those with established CVD, aspirin use has been documented to decrease the risk of a first myocardial infarction (MI). Its effects on stroke and vascular death are less conclusive. The use of aspirin in these individuals is recommended only for those whose risk for cardiovascular events (based on coronary risk assessment tools) is sufficiently high that it outweighs the risk for GI complications. Secondary prevention refers to the use of aspirin to prevent cardiovascular events in patients with established CVD such as an MI, stroke, or angina. The use of aspirin in these individuals is recommended based on a documented decrease in future cardiovascular events and mortality. The risk for GI events with aspirin is at least additive to the risk for these events in those who also are receiving therapy with a nonsteroidal anti-inflammatory drug. Patients being treated with aspirin, even at 81 mg/day for cardioprotection, should be assessed for factors that increase the risk for GI injury. Studies have confirmed that co-therapy with a proton pump inhibitor (PPI) or misoprostol decreases the risk for GI injury and complications. Although both classes of such gastroprotective agents are effective, treatment with a PPI is tolerated better, with fewer patients discontinuing the drug because of side effects such as diarrhea. |
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