Abstract
Background: Administration of aspirin has the potential for significant side effects of gastrointestinal (GI) injury mainly caused by gastric acid stimulation, especially in long-term users or users with original gastrointestinal diseases. The debate on the optimal treatment of aspirin-induced gastrointestinal injury is ongoing. We aimed to compare and rank the different treatments for aspirin-induced gastrointestinal injury based on current evidence.Methods: We searched PubMed, EMBASE, Cochrane Library (Cochrane Central Register of Controlled Trials), and Chinese databases for published randomized controlled trials (RCTs) of different treatments for aspirin-induced gastrointestinal injury from inception to 1 May 2021. All of the direct and indirect evidence included was rated by network meta-analysis under a Bayesian framework.Results: A total of 10 RCTs, which comprised 503 participants, were included in the analysis. The overall quality of evidence was rated as moderate to high. Eleven different treatments, including omeprazole, lansoprazole, rabeprazole, famotidine, geranylgeranylacetone, misoprostol, ranitidine bismuth citrate, chili, phosphatidylcholine complex, omeprazole plus rebamipide, and placebo, were evaluated in terms of preventing gastrointestinal injury. It was suggested that omeprazole plus rebamipide outperformed other treatments, whereas geranylgeranylacetone and placebo were among the least treatments.Conclusion: This is the first systematic review and network meta-analysis of different treatments for aspirin-induced gastrointestinal injury. Our study suggested that omeprazole plus rebamipide might be considered the best option to treat aspirin-induced gastrointestinal injury. More multicenter, high quality, large sample size randomized controlled trials will confirm the advantages of these medicines in the treatment of aspirin-induced gastrointestinal injury in the future.
Highlights
Aspirin is a well-known baseline antiplatelet agent, serving as the primary and secondary prevention as well as the treatment of ischemic stroke, acute myocardic infarction, transient ischemic attack, acute coronary syndrome, and peripheral artery diseases
Omeprazole plus rebamipide had the highest number of significant differences compared with the other medications that are used clinically to prevent aspirininduced gastrointestinal injury
The indirect mechanism of damage to the gastrointestinal mucosa by aspirin is the nonreversible inactivation of cyclooxygenase (COX), which inhibits the conversion of arachidonic acid to prostaglandin H2 (PGH2) in platelets (Hart and Bailey, 2002), subsequently affecting the production of prostaglandins prostaglandins E2 (PGE2) and prostaglandins I2 (PGI2)
Summary
Aspirin is a well-known baseline antiplatelet agent, serving as the primary and secondary prevention as well as the treatment of ischemic stroke, acute myocardic infarction, transient ischemic attack, acute coronary syndrome, and peripheral artery diseases Many studies have shown that the administration of aspirin has the potential for significant side effects of gastrointestinal (GI) symptoms including mucosal lesions, bleeding or peptic ulcers, especially in long-term users or users with origin gastrointestinal diseases The aspirin-induced gastric injury is a chronic inflammation mainly caused by gastric acid stimulation, as aspirin break the gastric mucosal barrier; gastric acid is capable of breaking the mucosal epithelial cells directly, causing inflammation, bleeding, and gastric ulcer. Administration of aspirin has the potential for significant side effects of gastrointestinal (GI) injury mainly caused by gastric acid stimulation, especially in long-term users or users with original gastrointestinal diseases. The debate on the optimal treatment of aspirin-induced gastrointestinal injury is ongoing. We aimed to compare and rank the different treatments for aspirin-induced gastrointestinal injury based on current evidence
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