Upper gastrointestinal haemorrhage associated with low‐dose aspirin and anti‐thrombotic drugs – a 6‐year analysis and comparison with non‐steroidal anti‐inflammatory drugs

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Abstract
Summary: Background:  Low‐dose aspirin and other anti‐thrombotic therapy has been increasingly used for vascular protection.Aim:  To assess the possibility that the incidence of upper gastrointestinal blood loss has changed in subjects using these agents in comparison with non‐steroidal anti‐inflammatory drugs.Methods:  We studied the characteristics of all patients with acute upper gastrointestinal haemorrhage and attending a single hospital at 3 points over a 6‐year period: 1996 (n = 204), 1999 (n = 224) and in 2002 (n = 252).Results:  The incidence of haemorrhage in subjects taking low‐dose aspirin rose from 15 per 100 000 of the population per annum in 1996, to 18 in 1999 and 27 in 2002 (P = 0.004). The respective incidence in subjects taking other anti‐thrombotic drugs was 4, 8, and 12 (P < 0.001). No significant change was detected in non‐steroidal anti‐inflammatory drug users. However, acute myocardial infarction mortality was 216 per 100 000 in 1996, 221 in 1999 and fell to 169 in 2002 (P < 0.001).Conclusions:  The incidence of upper gastrointestinal haemorrhage in users of low‐dose aspirin and other anti‐thrombotic drugs has been steadily rising. This has been paralleled by a fall in cardiac mortality.