Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis
BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7270.1183 (Published 11 November 2000) Cite this as: BMJ 2000;321:1183- Sheena Derry, research assistant,
- Yoon Kong Loke, clinical lecturer in clinical pharmacology (yoon.loke{at}clinpharm.ox.ac.uk)
- Correspondence to: Y K Loke
- Accepted 15 August 2000
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.
Footnotes
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Funding SD was supported by a grant from the Sir Jules Thorne Trust.
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Competing interests None declared.
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A further table and figure plus the references for the included studies appear on the BMJ's website