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Meta-Analysis
. 2000 Nov 11;321(7270):1183-7.
doi: 10.1136/bmj.321.7270.1183.

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

S Derry  1 , Y K Loke
Affiliations
Meta-Analysis

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

S Derry et al. BMJ. .

Abstract

Objectives: To assess the incidence of gastrointestinal haemorrhage associated with long term aspirin therapy and to determine the effect of dose reduction and formulation on the incidence of such haemorrhage.

Design: Meta-analysis of 24 randomised controlled trials (almost 66 000 participants).

Intervention: Aspirin compared with placebo or no treatment, for a minimum of one year.

Main outcome measures: Incidence of gastrointestinal haemorrhage.

Results: Gastrointestinal haemorrhage occurred in 2.47% of patients taking aspirin compared with 1.42% taking placebo (odds ratio 1.68; 95% confidence interval 1.51 to 1.88); the number needed to harm was 106 (82 to 140) based on an average of 28 months' therapy. At doses below 163 mg/day, gastrointestinal haemorrhage occurred in 2.30% of patients taking aspirin compared with 1.45% taking placebo (1.59; 1.40 to 1.81). Meta-regression showed no relation between gastrointestinal haemorrhage and dose. For modified release formulations of aspirin the odds ratio was 1.93 (1.15 to 3.23).

Conclusions: Long term therapy with aspirin is associated with a significant increase in the incidence of gastrointestinal haemorrhage. No evidence exists that reducing the dose or using modified release formulations would reduce the incidence of gastrointestinal haemorrhage.

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Figures

Figure 1
Figure 1
Peto odds ratio for gastrointestinal haemorrhage with aspirin. SALT=Swedish aspirin low dose trial; TPT=thrombosis prevention trial; USPHS=US physicians health study; EAFT=European atrial fibrillation trial; UK-TIA=UK transient ischaemic attack aspirin trial; CDPA=coronary drug project aspirin study; PARIS=persantine-aspirin reinfarction study; AMIS=aspirin myocardial infarction study; CCSG=Canadian Cooperative Study Group
Figure 2
Figure 2
Meta-regression of Peto odds ratio for gastrointestinal haemorrhage against dose of aspirin (size of circle is proportional to size of trial)
See this image and copyright information in PMC

Comment in

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