Aspirin, even at low dose, carries risk of gastrointestinal bleeding

November 09, 2000

Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis

Long term use of aspirin to prevent heart problems carries an increased risk of gastrointestinal bleeding, according to a study in this week's BMJ. Furthermore, no evidence exists that reducing the dose or using expensive "modified release" formulations of aspirin would reduce the likelihood of bleeding.

Researchers at the Radcliffe Infirmary in Oxford analysed 24 previous studies of aspirin, involving almost 66,000 patients, to establish the risk of gastrointestinal bleeding from long term treatment with aspirin. There were two main results. Firstly, bleeding occurred, on average, in 2.5% of patients taking aspirin compared with 1.4% who were not; this difference was statistically significant. Secondly, there was no evidence to suggest that switching to a low dose or modified release formulation of aspirin would reduce the problem.

Given the widespread use of aspirin for the prevention of heart problems, these findings have important implications for everyday practice, say the authors. Patients and doctors need to consider the trade-off between the benefits and harms of long term treatment with aspirin, they conclude.

In an accompanying editorial, Martin Tramr argues that we do not know who should be given what dose of aspirin and for how long. Physicians have been treating their patients with low dose aspirin on the understanding that they did more good than harm, yet innovative research is needed to estimate rare events with confidence, he concludes.

[Paper]: Yoon Kong Loke, University of Oxford, Radcliffe Infirmary, Oxford, UK
Tel: +44 (0)1865 241 091 or switchboard +44 (0)1865 741 166 (bleep number 1169)
Fax: +44 (0)1865 791 712 Email:

[Editorial]: Martin Tramr, Division of Anaesthesiology, Geneva University Hospitals, Switzerland
Tel: +41 22 382 7403 (Not available on Thursday 9 November)
Fax: +41 22 382 7511


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