NEW YORK (Reuters Health) – Continuing to take low-dose aspirin after endoscopic treatment of a bleeding peptic ulcer raises the risk for re-bleeding but may also reduce mortality rates, a report from Hong Kong suggests.

Whether patients with cardiovascular risk factors should continue on their low-dose aspirin regimens after endoscopic hemostasis of peptic ulcer bleeding has not been clear, Dr. Joseph J. Y. Sung, from the Chinese University of Hong Kong, and colleagues note.

In the new study, Dr. Sung’s team sought to determine whether continuing aspirin therapy, with the addition of proton pump inhibitors, was not inferior to stopping aspirin therapy in these patients.

The randomized trial featured 156 patients with peptic ulcer bleeding, all of whom had been taking low-dose aspirin. Patients were assigned to receive aspirin (80 mg/day) or placebo for 8 weeks after endoscopic therapy. All subjects also received intravenous pantoprazole (80 mg bolus, 8 mg/hour for 72 hours) followed by oral pantoprazole (40 mg/day) until the end of the study.

In the December 1st online issue of the Annals of Internal Medicine, the researchers report that the rate of recurrent ulcer bleeding at 30 days was nearly twice as high in the aspirin group as in the placebo group: 10.3% vs. 5.4% (p = 0.25). However, the all-cause mortality rate at 8 weeks was much lower in the aspirin group: 1.3% vs. 12.9% (p = 0.005).

Further analysis showed that deaths due to cardiovascular, cerebrovascular, and gastrointestinal causes were less common in the aspirin group than in the placebo group (1.3% vs. 10.3%, p = 0.016).

The authors note that their study was small, and that some deaths in the placebo group were “from causes not normally prevented by aspirin.”

Even so, they conclude, “Early resumption of low-dose aspirin therapy with proton-pump inhibitors in patients with bleeding ulcers and cardiovascular diseases should be considered.”

Reference:
Ann Intern Med 2009.