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

Abstract

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.

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

“…Comment: LDA treatment is associated with high prevalence and incidence of peptic ulcers [121]. Esomeprazole reduces the occurrence of peptic ulcers in patients taking LDA [122], and esomeprazole was superior to famotidine in preventing upper GI complications related to LDA, clopidogrel, and thrombolytics [123].…”

Platelets: Small in Size But Essential in the Regulation of Vascular Homeostasis – Translation From Basic Science to Clinical Medicine –

“…95 A prospective registry of Japanese patients taking daily aspirin 96 demonstrated that 6.5% of gastroduodenal ulcers and 29.2% of gastro-enteric erosions, respectively, were detected in 1,454 stable outpatients receiving aspirin for cardioprotective purposes. 97 Proton-pump inhibitors (PPI) are effective in prevention of aspirin-induced gastroduodenal injury, 98 but regular use of PPI is recommended only for high-risk patients. 99 Of note, a recent international prospective registry of patients with or at risk of atherothrombosis revealed a lower incidence of serious bleeding events in patients from Japan as compared with other regions of the world.…”

Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

“…We reported the first study that found H. pylori infection as an independent risk factor for upper GI bleeding in LDA users (OR 4.7, 95 % CI 2.0-10.9) [56]. In the MAGIC study, published recently, H. pylori was associated with an increased risk of ulcer in LDA users (OR 1.83, CI 95 % 1.18-2.88, p = 0.0082) [73]. In contrast, a cohort study showed that H. pylori infection may be a protective factor against LDA-induced gastric erosions [74].…”