Cardioprotective aspirin users and their excess risk of upper gastrointestinal complications.
Cardioprotective aspirin users and their excess risk of upper gastrointestinal complications.
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DOI：
10.1186/1741-7015-4-22
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发表时间：
2006-09-20
期刊：
影响因子：
9.3
通讯作者：
García Rodríguez LA
中科院分区：
文献类型：
--
作者：
Hernández-Díaz S;García Rodríguez LA
为了平衡小剂量阿司匹林对心血管的益处和引起的胃肠道损害，研究考虑了每个人的冠心病风险，但没有考虑他们的胃肠道风险。我们在实际临床实践中描述了小剂量阿司匹林使用者的胃肠道风险特征，并估计了不同胃肠道风险特征的患者中可归因于阿司匹林的上胃肠道并发症的超额风险。为了根据主要的胃肠道危险因素(即高龄、男性、有胃溃疡病史和使用非类固醇消炎药)来描述阿司匹林使用者的特征，我们使用了英国的普通医学研究数据库和西班牙的Base de Datos parla Investigación Farmaco Epoloógica en Atención Primaria。为了根据主要的胃肠道危险因素估计上消化道并发症的基线风险，以及在这些因素的水平内可归因于阿司匹林的额外风险，我们使用了先前发表的关于上胃肠道并发症的绝对风险和相对风险的荟萃分析。超过60%的阿司匹林使用者年龄在60岁以上，4%到6%的人最近有消化性溃疡的病史，超过13%的人使用其他非类固醇抗炎药。据估计，每年每1000名阿司匹林使用者中，可归因于阿司匹林的上消化道并发症的平均超额风险约为5例。然而，额外的风险与潜在的胃肠道风险是平行的，在超过10%的阿司匹林使用者中，每1000人年可能会增加10例以上。在权衡阿司匹林对个别患者的危害和益处时，除了心血管风险之外，还必须考虑潜在的胃肠道风险因素。胃肠道损害可能会抵消某些胃肠道风险高、心血管风险低的患者的心血管益处。
To balance the cardiovascular benefits from low-dose aspirin against the gastrointestinal harm caused, studies have considered the coronary heart disease risk for each individual but not their gastrointestinal risk profile. We characterized the gastrointestinal risk profile of low-dose aspirin users in real clinical practice, and estimated the excess risk of upper gastrointestinal complications attributable to aspirin among patients with different gastrointestinal risk profiles. To characterize aspirin users in terms of major gastrointestinal risk factors (i.e., advanced age, male sex, prior ulcer history and use of non-steroidal anti-inflammatory drugs), we used The General Practice Research Database in the United Kingdom and the Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria in Spain. To estimate the baseline risk of upper gastrointestinal complications according to major gastrointestinal risk factors and the excess risk attributable to aspirin within levels of these factors, we used previously published meta-analyses on both absolute and relative risks of upper gastrointestinal complications. Over 60% of aspirin users are above 60 years of age, 4 to 6% have a recent history of peptic ulcers and over 13% use other non-steroidal anti-inflammatory drugs. The estimated average excess risk of upper gastrointestinal complications attributable to aspirin is around 5 extra cases per 1,000 aspirin users per year. However, the excess risk varies in parallel to the underlying gastrointestinal risk and might be above 10 extra cases per 1,000 person-years in over 10% of aspirin users. In addition to the cardiovascular risk, the underlying gastrointestinal risk factors have to be considered when balancing harms and benefits of aspirin use for an individual patient. The gastrointestinal harms may offset the cardiovascular benefits in certain groups of patients where the gastrointestinal risk is high and the cardiovascular risk is low.
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