Assessment of both gastrointestinal and cardiovascular risks vs. the benefits of low-dose aspirin for individual patients can be difficult in clinical practice.
Dr Lanas and colleagues developed a tool to estimate cardiovascular and gastrointestinal risks to facilitate the clinical decision-making process.
The team constructed risk-ratio estimations, and determined the incidence of cardiovascular events and upper gastrointestinal complications according to the presence of different risk factors.
For upper gastrointestinal complications, the researchers assumed a baseline incidence of 1 case per 1000-persons-year, a 2-fold increased risk with low-dose aspirin, and estimated a 60% gastrointestinal risk reduction with proton pump inhibitors co-therapy, and a 60% risk reduction with H. pylori eradication in patients with a history of peptic ulcer.
|The use of PPIs reduces the number of complication events induced by low-dose aspirin|
|Alimentary Pharmacology & Therapeutics|
The research team reported that the calculator can be found at http://www.asariskcalculator.com.
In patients with low cardiovascular risk the number of gastrointestinal complications induced by low-dose aspirin may be greater than the number of cardiovascular events prevented.
The doctors recommend aspirin in patients with high cardiovascular risk, low-dose aspirin, but the number of gastrointestinal complications induced may still overcome the cardiovascular events saved.
The use of proton pump inhibitors reduces the number of complication events induced by low-dose aspirin, but the number of cardiovascular events saved may still be offset by the number of gastrointestinal complications induced in patients at very high gastrointestinal risk.
Dr Lanas' team commented, "There are many clinical situations where the number of potential upper gastrointestinal complications induced by low-dose aspirin may exceed the number of potentially prevented cardiovascular events."
"A risk calculator should guide physicians in choosing appropriate therapy and maximize the aspirin benefit."