Aspirin and Its Adverse Effects: Minimizing the Risk of Gastrointestinal Bleeding and Peptic Ulcer in Antiplatelet Therapy

Aspirin, known for its antiplatelet effect, has been a cornerstone in the prevention of cardiovascular events. However, its use is not without risks, with gastrointestinal bleeding being one of the most concerning adverse effects. This article explores how physicians can minimize these risks when prescribing aspirin, particularly in patients with additional risk factors.

Delving into the Adverse Effects of Aspirin

The use of aspirin for the primary prevention of cardiovascular diseases has been a topic of debate due to its potential to cause bleeding. A recent meta-analysis demonstrated that while aspirin reduces cardiovascular events, it also increases the risk of major bleeding [1]. This risk is particularly relevant in older patients, where the incidence of gastrointestinal bleeding is higher [2].

Moreover, prolonged use of aspirin may elevate the risk of peptic ulcer, which in turn increases the likelihood of bleeding. Studies have shown that combining aspirin with other medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), can exacerbate this risk [3]. On the other hand, aspirin is also associated with Reye's syndrome in children, limiting its use in pediatric populations [4].

Conclusions and Recommendations to Minimize Bleeding Risk

To minimize the risk of bleeding when prescribing aspirin, it is crucial to conduct an individualized risk-benefit assessment. In patients at high risk for cardiovascular events, aspirin may be beneficial, but the use of mitigation strategies such as concomitant use of proton pump inhibitors to protect the gastric mucosa should be considered [5].

Additionally, it is important to consider the dosage and duration of treatment. Studies suggest that lower doses of aspirin may be effective and reduce the risk of bleeding [6]. Finally, educating patients about the warning signs of bleeding and the need for regular follow-up are essential components of a safe management strategy.

Referencias

• [1] Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events: A Systematic Review and Meta-analysis
• [2] Major GI bleeding in older persons using aspirin: incidence and risk factors in the ASPREE randomised controlled trial
• [3] Bleeding Risk with Long-Term Low-Dose Aspirin: A Systematic Review of Observational Studies
• [4] Aspirin and the Primary Prevention of Cardiovascular Diseases: An Approach Based on Individualized, Integrated Estimation of Risk
• [5] Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement
• [6] Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials

Created 6/1/2025