Impact of Gastrointestinal Problems on Adherence to Low-Dose Acetylsalicylic Acid

Abstract

Among the US cohort studied (i.e. low-dose ASA users with experience of upper GI problems), poor adherence to low-dose ASA treatment for both secondary and high-risk primary CV prevention was common.

Patterns in the Use of Low-Dose Acetylsalicylic Acid and Other Therapies Following Upper Gastrointestinal Bleeding

“…Patients who are not re-prescribed therapy may be left at high risk of secondary CV events if they are not treated with an alternative antithrombotic medication. Several recent studies have indicated that some patients may discontinue their ASA owing to GI adverse effects [33][34][35].…”

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…Lee et al 1058 recommend an aspirin intake dose of at least 325 mg twice daily for optimal symptom control, but current reports showed that even aspirin doses of 650 mg/day are associated with a considerable risk of gastrointestinal bleeding. 1059,1060 In 2013, the first double-blind placebo-controlled clinical trial was published, investigating adaptive aspirin desensitization with an initial challenge-dose reaching 800 mg aspirin over 1 day followed by a maintenance dose of just 100 mg daily. This low-dose protocol was revealed to be safe, with less than 3% of patients in the treatment group complaining about gastric irritations, all of which could continue the treatment after adding a PPI.…”

Multinational, double-blind, randomised, placebo-controlled, prospective study of esomeprazole in the prevention of recurrent peptic ulcer in low-dose acetylsalicylic acid users: the LAVENDER study

“…However, long-term low-dose ASA use has been associated with upper GI problems such as GI symptoms,3 4 peptic ulcers and GI bleeding 3 – 8. Such problems are one of the main reasons for patients to discontinue, or take deliberate breaks from, their low-dose ASA therapy 4 9. Low-dose ASA discontinuation is associated with a markedly increased risk of serious adverse cardiovascular events within a short timeframe 10 – 12…”