Prospective Cohort Study of Gastrointestinal Complications and Vascular Diseases in Patients Taking Aspirin: Rationale and Design of the MAGIC Study

Origasa, Hideki; Goto, Shinya; Shimada, Kazuyuki; Uchiyama, Shinichiro; Okada, Yasushi; Sugano, Kentaro; Hiraishi, Hideyuki; Uemura, Naomi; Ikeda, Yasuo

doi:10.1007/s10557-011-6328-2

Cited by 10 publications

(14 citation statements)

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“…The details of the study design were published elsewhere [11]. Described briefly, the study consisted of high-risk CV patients taking low-dose aspirin for cardioprotection that were consecutively recruited from 63 nationwide institutions between April 2007 and September 2009.…”

Section: Methodsmentioning

confidence: 99%

Risk factor profiles, drug usage, and prevalence of aspirin-associated gastroduodenal injuries among high-risk cardiovascular Japanese patients: the results from the MAGIC study

et al. 2013

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BackgroundLow-dose aspirin is widely used for the prevention of cardiovascular events. The prevalence of gastroduodenal injuries and the risk factor profile including gastroprotective drug therapy needs to be clarified in Japanese patients taking daily aspirin for cardioprotection.MethodsThis Management of Aspirin-induced Gastro-Intestinal Complications (MAGIC) study was conducted with a prospective nationwide, multicenter, real-world registry of Japanese patients at high-risk of cardiovascular diseases who were taking regular aspirin (75–325 mg) for 1 month or more. All patients underwent endoscopic examination for detection of gastroduodenal ulcer and mucosal erosion. The risk factor profiles including the concurrent drug therapy were compared for those patients with gastroduodenal problems and those without.ResultsGastroduodenal ulcer and erosion were detected in 6.5, and 29.2 % of the 1,454 patients receiving aspirin, respectively. H. pylori infection was associated with an increased risk for ulcer: OR 1.83 (1.18–2.88 p = 0.0082). Risk of erosion was lower with enteric-coated aspirin than with buffered aspirin: odds ratio (OR) 0.47 (0.32–0.70, p = 0.0002). Patients receiving proton pump inhibitors had lower risks for both gastroduodenal ulcer and erosion: OR 0.34 (0.15–0.68, p = 0.0050) and 0.32 (0.22–0.46, p < 0.0001), respectively. However, those receiving histamine 2-receptor antagonists had reduced risks for erosion but not for ulcer: OR 0.49 (0.36–0.68, p < 0.0001).ConclusionGastroduodenal ulcer and erosion are common in Japanese patients taking low dose aspirin for cardioprotection. Proton pump inhibitors reduce the risk of gastroduodenal mucosal injury.Electronic supplementary materialThe online version of this article (doi:10.1007/s00535-013-0839-5) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Risk factor profiles, drug usage, and prevalence of aspirin-associated gastroduodenal injuries among high-risk cardiovascular Japanese patients: the results from the MAGIC study

et al. 2013

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“…A large number of elderly people with cardiovascular disease, cerebrovascular disease and chronic joint pain have been prescribed low-dose aspirin, antithrombotic drugs, NSAIDs and corticosteroids for primary or secondary prevention of cardiovascular disease, cerebrovascular disorders and arthralgia (18)(19)(20)(21)(22). In the present study, a univariate analysis focused on prescribed medications indicated that low-dose aspirin, antithrombotic drugs and corticosteroids are exacerbating factors for bleeding gastric and/or duodenal ulcers in elderly patients compared with nonelderly patients.…”

Section: Discussionmentioning

confidence: 67%

“…Several studies have identified the use of NSAIDs, including low-dose aspirin, as being a significant cause of gastroduodenal ulcers (12)(13)(14)(15)(16)(17)(18)(19). A large number of elderly people with cardiovascular disease, cerebrovascular disease and chronic joint pain have been prescribed low-dose aspirin, antithrombotic drugs, NSAIDs and corticosteroids for primary or secondary prevention of cardiovascular disease, cerebrovascular disorders and arthralgia (18)(19)(20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

“…The use of low-dose aspirin was closely related to an older age in the bleeding peptic ulcer patients. Low-dose aspirin prescribed for the primary and secondary prevention of vascular thromboembolism (23,24) exacerbates gastrointestinal mucosal injury, including bleeding peptic ulcers (14,18,25,26). In addition, the adverse effects of low-dose aspirin are enhanced when combined with antithrombotic therapy (27).…”

Section: Discussionmentioning

confidence: 99%

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Low-dose Aspirin and Comorbidities are Significantly Related to Bleeding Peptic Ulcers in Elderly Patients Compared with Nonelderly Patients in Japan

et al. 2014

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Objective The present study was conducted using data accumulated from our earlier study of bleeding peptic ulcers, focusing on elderly patients. Methods A total of 461 patients with bleeding peptic ulcers underwent emergency endoscopy at Saga Medical School Hospital between 1999 and 2011. Risk factors for bleeding peptic ulcers were compared between two groups: an elderly group (! 65 years old) and a nonelderly group (<65 years old). The relationship between drug use and age was examined using multiple logistic regression models. In the elderly group, the factors were compared between Period I (1999Period I ( -2005 and Period II (2006II ( -2011. Results The proportion of men and the incidence of Helicobacter pylori infection were lower in the elderly group than in the nonelderly group. The use of low-dose aspirin, antithrombotic drugs and corticosteroids, but not nonsteroidal anti-inflammatory drugs, was higher in the elderly group. A multiple logistic regression analysis of prescribed medications indicated that low-dose aspirin was more frequently used in the elderly group. The rate of comorbidities was higher and the hemoglobin levels were lower in the elderly group. The rates of rebleeding within one week and death within one month did not differ in the elderly group. Compared with that observed in Period I, the incidence of Helicobacter pylori infection was decreased and the rate of comorbidities was increased in Period II. Conclusion This study indicates that factors related to bleeding peptic ulcers in elderly patients have shifted from Helicobacter pylori infection to comorbidities associated with low-dose aspirin, suggesting a close relationship between low-dose aspirin therapy and comorbidities in elderly patients with peptic ulcers.

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“…In this edition of Cardiovascular Drugs and Therapy, Origasa and colleagues describe the rationale and design of the MAGIC Study, a large Japanese cohort study designed to assess the frequency of gastrointestinal complications associated with low-dose aspirin therapy [1]. Bleeding, particularly from the gastrointestinal tract is the most important adverse effect of aspirin but its frequency and consequences have not been well studied.…”

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confidence: 99%

The MAGIC Study and the Gastrointestinal Effects of Low-Dose Aspirin

McNeil

Tonkin

2011

Cardiovasc Drugs Ther

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Prospective Cohort Study of Gastrointestinal Complications and Vascular Diseases in Patients Taking Aspirin: Rationale and Design of the MAGIC Study

Cited by 10 publications

References 46 publications

Risk factor profiles, drug usage, and prevalence of aspirin-associated gastroduodenal injuries among high-risk cardiovascular Japanese patients: the results from the MAGIC study

Risk factor profiles, drug usage, and prevalence of aspirin-associated gastroduodenal injuries among high-risk cardiovascular Japanese patients: the results from the MAGIC study

Low-dose Aspirin and Comorbidities are Significantly Related to Bleeding Peptic Ulcers in Elderly Patients Compared with Nonelderly Patients in Japan

The MAGIC Study and the Gastrointestinal Effects of Low-Dose Aspirin

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