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All about aspirin

Low dose (75 mg) aspirin prescribing rose rapidly in the 1990s [1], as fast as that for proton pump inhibitors (Figure 1). The same paper tells us that hospital admissions for gastric and peptic ulcer rose by about 10-30% in 65-74s and 30-40% in over 75s. For duodenal ulcer, finished consultant episodes rose by 25% for men and women aged 65-74 years, and 30-50% for men and women over 75 years or over. It wasn't due to increased NSAID prescribing (Figure 1), and rocketing PPI consumption should have helped prevent these problems.

Figure 1: Prescribing of aspirin, NSAIDs and proton pump inhibitors (PPI) in England

Were the GI problems all down to aspirin? If each prescription was for 30 tablets (a conservative assumption) and one 75 mg tablet was taken a day, then by 1999 there would have been 900,000 more person years of exposure. Given that one or two gastrointestinal bleeds per 1000 patients on low dose aspirin, then low dose aspirin could account for 1000 to 2000 episodes of gastrointestinal bleeding, and that approximates the 1000 excess admissions actually observed.

We need to know that we are not doing more harm than good. This issue of Bandolier reviews the excellent evidence that that is so when the annual risk of a coronary event is about 1% or greater. For secondary prevention , low dose aspirin makes excellent sense, with nothing else much better. But aspirin does not beat anticoagulants for preventing stroke in nonvalvular atrial fibrillation.


  1. J Higham et al. Recent trends in admissions and mortality due to peptic ulcer in England: increasing frequency of haemorrhage among older subjects. Gut 2002 50: 460-464.

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