セッション情報 The 4th International Forum

I Drug-associated GI Injury:Advances of the pathogenesis and recent clinical topics 2. Recent clinical topics(b)Bowel injuries

タイトル IFI-2b-1:

Should aspirin be resumed in patients with a history of aspirin-related lower GI bleeding?

演者 Chan Francis K.L.(Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong)
共同演者
抄録 Management of aspirin users with a history of lower gastrointestinal(GI)bleeding is a dilemma. Resumption of aspirin may increase the risk of recurrent lower GI bleeding whereas stopping aspirin will increase the risk of cardiothrombotic events. In a single-center, retrospective cohort study, ASA users with a diagnosis of lower GI bleeding were identified according to prespecified criteria. After being discharged from the hospital, eligible patients were reviewed for recurrent lower GI bleeding, serious cardiovascular(CV)events, and death for up to 5 years. They were divided into 2 groups according to their cumulative exposure to ASA(ASA group versus non-user group). The endpoints were recurrent lower GI bleeding(defined as recurrent melena, hematochezia, and/or a drop in hemoglobin >2 g/dL without a bleeding source identified by gastroscopy)and serious CV events(as defined by the APTC criteria). An independent, blinded adjudication committee evaluated these endpoints according to predefined criteria. A total of 295 patients were eligible for the study(174 in the ASA group and 121 in the non-user group). The median follow-up was 2.7 years(range, 0.6-5.0)in the ASA group and 1.7 years(range, 0.2-4.7)in the non-user group. The cumulative incidence of recurrent lower GI bleeding in 5 years was 18.9%(95% CI, 13.3%-25.3%)in the ASA group compared to 6.9%(95% CI, 3.2%-12.5%)in the non-user group(p=0.007). Serious CV events at 5 years was 22.8%(95% CI, 16.6%-29.6%)in the ASA group compared to 36.5%(95% CI, 27.4%-45.6%)in the non-user group(p=0.017). Other causes of death at 5 years was 8.2%(95% CI, 4.6% to 13.2%)in ASA group compared to 26.7%(95% CI, 18.7% to 35.4%)in the non-user group(p<0.001). On multivariable analysis, ASA use was independently associated with increased risk of recurrent lower GI bleeding(hazard ratio 2.76;95% CI, 1.26-6.07, p=0.011). ASA use decreases(hazard ratio 0.59;95% CI, 0.37-0.91, p=0.019)whereas comorbidity increases(hazard ratio 1.99;95% CI, 1.23-3.23, p=0.005)the risk of serious CV events. This cohort study showed that among ASA users with a history of lower GI bleeding, resumption of ASA significantly increased the risk of recurrent lower GI bleeding but reduced the risk of serious CV events and other causes of death.
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