Aspirin dose, not duration, tied to GI bleeding risk

Men who took more than 14 aspirin per week were more than twice as likely to report upper gastrointestinal bleeding as were men who reported no aspirin use, but increased duration of use did not appear to raise the risk of GI bleeding, Dr. Edward Huang said
at the annual meeting of the American College of Gastroenterology.
Evidence regarding the impact of aspirin use on GI bleeding is conflicting because of the limitations of previous studies, said Dr. Huang of Massachusetts General Hospital in Boston.
To examine the long-term effects of aspirin dose and duration on GI bleeding, Dr. Huang and his colleagues conducted a prospective study of 32,989 participants in the Health Professionals Follow-up Study, a longitudinal study of male health professionals in the United States. In 2006 and 2008, participants were asked to report any past episodes of GI bleeding severe enough to require hospitalization or blood transfusion.
During a mean 14-year follow-up period, 707 men had an episode of major GI bleeding. After adjustment for risk factors including use of NSAIDs, age, smoking status, exercise, and body mass index, the risk ratios for upper GI bleeding were 1.05 for men who took 0.5-1.5 standard aspirin tablets (325 mg) per week, 1.31 for those who took 2-5 tablets per week, 1.63 for those who took 6-14 tablets per week, and 2.40 for those who took more than 14 tablets per week, compared with men who reported no aspirin use.
Short-term aspirin use was defined as less than 5 years, and long-term use was defined as 5 years or longer. “The dose-response relationship is significant regardless of duration of use,” Dr. Huang noted.
By contrast, longer duration of use was not significantly associated with an increased risk of upper GI bleeding, Dr. Huang said. However, individuals who use aspirin the longest tend to use the highest dose, he added.
The study was limited by the self-selected aspirin use on the part of the participants, but Dr. Huang emphasized that the participants were well-educated health professionals. Although the study included men only, he noted that similar reviews of data from the Nurses’ Health Study have yielded similar findings.
The average age of the men when they enrolled in the study was 60 years, and those with a history of peptic ulcer disease were excluded.
The results suggest that both short-term and long-term aspirin users can minimize the risk of upper GI bleeding by using the lowest effective dose, Dr. Huang said.
Dr. Huang had no financial conflicts to disclose.