Long-term use of aspirin and the risk of gastrointestinal bleeding

Abstract

Background: In short-term trials, aspirin is associated with gastrointestinal bleeding. However, the effect of dose and duration of aspirin use on risk remains unclear.

Methods: We conducted a prospective study of 87,680 women enrolled in the Nurses' Health Study in 1990 who provided biennial data on aspirin use. We examined the relative risk (RR) of major gastrointestinal bleeding requiring hospitalization or blood transfusion.

Results: During a 24-year follow-up, 1537 women reported a major gastrointestinal bleeding. Among women who used aspirin regularly (≥2 standard [325 mg] tablets/week), the multivariate RR of gastrointestinal bleeding was 1.43 (95% confidence interval [CI], 1.29-1.59) when compared with nonregular users. Compared with women who denied any aspirin use, the multivariate RRs of gastrointestinal bleeding were 1.03 (95% CI, 0.85-1.24) for women who used 0.5 to 1.5 standard aspirin tablets/week, 1.30 (95% CI, 1.07-1.58) for women who used 2 to 5 tablets/week, 1.77 (95% CI, 1.44-2.18) for women who used 6 to 14 tablets/week, and 2.24 (95% CI, 1.66-3.03) for women who used more than 14 tablets/week (P(trend)<.001). Similar dose-response relationships were observed among short-term users (≤5 years; P(trend)<.001) and long-term users (>5 years; P(trend)<.001). In contrast, after adjustments were made for dose, increasing duration of use did not confer a greater risk of bleeding (P(trend) = .28).

Conclusion: Regular aspirin use is associated with gastrointestinal bleeding. Risk seems more strongly related to dose than duration of aspirin use. Efforts to minimize adverse effects of aspirin therapy should emphasize using the lowest effective dose among both short- and long-term users.

Figure 1

Multivariate-adjusted Stratified Analyses of Gastrointestinal Bleeding Risk According to Aspirin Use. Multivariate hazard ratios are adjusted for age (years), NSAID use (yes or no), smoking status (never, past, current), body mass index (<21, 21-22.9, 23-24.9, 25-29.9, ≥30 kg/m²), physical activity (<1.7, 1.7-4.5, 4.6-10.5, 10.6-22.0, ≥22.1 mets/week), alcohol (0, 0.1-4.9, 5-14, ≥15 g/day). For each stratified analysis, the stratification variable was omitted from the model.