Aspirin and Antiplatelet Medications (cont.)
What can be done to reduce the risk of ulcers from long-term aspirin use?
Long-term low dose aspirin use is generally safe. An
estimated 10% of the patients taking long-term aspirin (75-325 mg/day) can
develop ulcers. Most of these ulcers were asymptomatic (no abdominal pain or
bleeding). Patients at a higher risk of developing ulcers with low dose aspirin
included elderly patients age 70 years and older, and patients with
H. pylori
stomach infection (see below). The risk of significant ulcer bleeding from aspirin is low
(approximately 1%). One can reduce the risk of bleeding by adding a daily dose
of a proton pump inhibitor for example,
pantoprazole (Protonix),
esomeprazole (Nexium),
rabeprazole (Aciphex), or
lansoprazole (Prevacid,
Prevacid SoluTab), and omeprazole
(Prilosec, Zegerid).
Chronic H. Pylori infection of the stomach is found in up to 30% of adults in
the U.S. Patients with gastritis due to H. pylori will have a higher risk of
bleeding when given aspirin or NSAIDs long-term. Eradication of H. pylori from
the stomach with antibiotics can reduce the risk of bleeding from chronic
aspirin use.
Buffered and coated aspirin do not seem to have any beneficial effect in
preventing ulcers and ulcer bleeding.
What are the limitations of aspirin treatment?
Aspirin is not always effective in preventing strokes and heart attacks.
Examples of possible causes of aspirin failure include:
- Poor patient compliance (not taking the medication regularly)
- Inadequate dosing
- Concurrent intake of other NSAIDs such as ibuprofen that interferes with
the anti-platelet action of aspirin
- Activation of platelet aggregation via pathways not blocked by aspirin
- Aspirin resistance
Next: What is aspirin resistance? »
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