It is uncertain whether aspirin therapy should be continued after endoscopic hemostatic therapy in patients who develop peptic ulcer bleeding while receiving low-dose aspirin.
Continuing aspirin therapy with proton-pump inhibitors after endoscopic control of ulcer bleeding was not inferior to stopping aspirin therapy, in terms of recurrent ulcer bleeding in adults with cardiovascular or cerebrovascular diseases.
Dr Joseph Sung and colleagues from Hong Kong conducted a parallel randomized, placebo-controlled noninferiority trial, in which both patients and clinicians were blinded to treatment assignment, from 2003 to 2006 by using computer-generated numbers in concealed envelopes.
The team reported that 78 patients received 80 mg/d aspirin, and another 78 received placebo for 8 weeks immediately after endoscopic therapy.
|Recurrent ulcer bleeding was 10% in the aspirin group|
|Annals of Internal Medicine|
All patients received a 72-hour infusion of pantoprazole followed by oral pantoprazole.
All patients completed follow-up.
The primary end point was recurrent ulcer bleeding within 30 days confirmed by endoscopy.
Secondary end points were all-cause and specific-cause mortality in 8 weeks.
The researchers evaluated 156 patients in an intention-to-treat analysis.
The team noted that 3 patients withdrew from the trial before finishing follow-up.
Recurrent ulcer bleeding within 30 days was 10% in the aspirin group and 5% in the placebo group.
The team found that patients who received aspirin had lower all-cause mortality rates than patients who received placebo.
Patients in the aspirin group had lower mortality rates attributable to cardiovascular, cerebrovascular, or gastrointestinal complications than patients in the placebo group.
The team observed that 2 patients with recurrent bleeding in the placebo group did not have further endoscopy.
Dr Joseph Sung's team concluded, “Among low-dose aspirin recipients who had peptic ulcer bleeding, continuous aspirin therapy may increase the risk for recurrent bleeding but potentially reduces mortality rates.”
“Larger trials are needed to confirm these findings.”