Abstract
Background: Low-dose aspirin is the most common drug used for prevention of cardiovascular and cerebrovascular events. Long-term aspirin therapy can induce gastroduodenal mucosal injury, even in a very low dose (10 mg daily). The frequency of gastroduodenal injuries among long-term low-dose aspirin users in Indonesia is currently unknown. The aim of this study is to determine the prevalence of gastroduodenal mucosal injury, endoscopic findings, and influencing factors among long-term low-dose aspirin users in Cipto Mangunkusumo Hospital.Method: This study was a cross-sectional study conducted in Cipto Mangunkusumo Hospital, Jakarta. Subjects were patients aged ≥ 18 years old who had been using low-dose aspirin (75-325 mg) for at least the preceding 28 days. Ninety-five subjects were recruited consecutively in the period of December 2015 – April 2016. History taking, upper endoscopic examination, and histopathology examination for Helicobacter pylori infection were performed in all subjects. Endoscopic findings such as erosions and ulcers were assessed as mucosal injuries. Data were analysed to find prevalence, bivariate analysis (Chi-square test), and multivariate analysis (logistic regression test).Results: Mucosal injury was found in 49 subjects (51.6%; 95% CI: 41.6–61.7%), mucosal erosion in 38 subjects (40%; 95% CI: 30.2–49.9%) and ulcers in 11 subjects (11.6%; 95% CI: 5.2–18.0%). Only 44.9% patients with mucosal injury had dyspepsia symptoms. Double antiplatelet therapy increased the risk of mucosal injury (OR = 3.3; 95% CI: 1.3–8.5). However, proton pump inhibitor (PPI) decreased the risk of mucosal injury (OR = 0,2; 95% CI: 0,04 – 0,60).Conclusion: Gastroduodenal mucosal injury was found in more than half of long-term low-dose aspirin users. Double antiplatelet therapy increased the risk of mucosal injury, while PPI effectively reduced the risk.
Highlights
Low-dose aspirin (75325 mg) is the most frequently used prophylactic drugs for cardiovascular and cerebrovascular events.[1,2,3] Use of aspirin can decrease 10-20 per 1,000 cardiovascular events and mortality rates due to vascular diseases.[1]
Based on the endoscopy results of upper gastrointestinal tract, gastroduodenal mucosal injury was found in 49 patients (51.6%; 95% CI: 41.6-61.7%), with erosive gastritis appearance in 38 patients (40%; 95% CI: 30.2-49.9%) and peptic ulcer in 11 patients (11.6%; 95% CI: 5.2-18.0%)
In the group of patients whose upper gastrointestinal endoscopic results revealed mucosal injury appearance, we found 57.1% patients whose age were above 65 years old; 40.8% used antithrombotic combination; 4.1% used warfarin; 8.2% used nonsteroidal anti-inflammatory drugs (NSAIDs); 8.2% suffered from H. pylori infection; and 38.8% suffered from diabetes mellitus
Summary
Low-dose aspirin (acetylsalicylic acid or ASA) (75325 mg) is the most frequently used prophylactic drugs for cardiovascular and cerebrovascular events.[1,2,3] Use of aspirin can decrease 10-20 per 1,000 cardiovascular events and mortality rates due to vascular diseases.[1]. Mucosal erosion took place in approximately 60% of aspirin users, while peptic ulcer was found in 11-19% patients.[7,8] more studies associated the use of aspirin with gastrointestinal bleeding.[9,10,11,12,13,14] In a large study involving 27,694 patients, upper gastrointestinal bleeding was found in 2.6% of aspirin users.[15] But, clinical symptom does not always present in mucosal injury due to aspirin administration.[7,16] endoscopic examination of upper gastrointestinal tract should be performed in long-term low-dose aspirin users regardless of the presence of clinical complaints. Long-term aspirin therapy can induce gastroduodenal mucosal injury, even in a very low dose (10 mg daily). The frequency of gastroduodenal injuries among long-term low-dose aspirin users in Indonesia is currently unknown. The aim of this study is to determine the prevalence of gastroduodenal mucosal injury, endoscopic findings, and influencing factors among long-term low-dose aspirin users in Cipto Mangunkusumo Hospital
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