Low-dose acetylsalicylic acid use and the risk of upper gastrointestinal bleeding: a meta-analysis of randomized clinical trials and observational studies.

IF 2.7 4区医学 Q2 Medicine

Canadian Journal of Gastroenterology Pub Date : 2013-03-01 DOI:10.1155/2013/596015

Vera E Valkhoff, Miriam C J M Sturkenboom, Catherine Hill, Sander Veldhuyzen van Zanten, Ernst J Kuipers

{"title":"Low-dose acetylsalicylic acid use and the risk of upper gastrointestinal bleeding: a meta-analysis of randomized clinical trials and observational studies.","authors":"Vera E Valkhoff, Miriam C J M Sturkenboom, Catherine Hill, Sander Veldhuyzen van Zanten, Ernst J Kuipers","doi":"10.1155/2013/596015","DOIUrl":null,"url":null,"abstract":"Background: Low-dose acetylsalicylic acid (LDA, 75 mg/day to 325 mg/day) is recommended for primary and secondary prevention of cardiovascular events, but has been linked to an increased risk of upper gastrointestinal bleeding (UGIB).Objective: To analyze the magnitude of effect of LDA use on UGIB risk.Methods: The PubMed and Embase databases were searched for randomized controlled trials (RCTs) reporting UGIB rates in individuals receiving LDA, and observational studies of LDA use in patients with UGIB. Studies were pooled for analysis of UGIB rates.Results: Eighteen studies were included. Seven RCTs reported UGIB rates in individuals randomly assigned to receive LDA (n=22,901) or placebo (n=22,923). Ten case-control studies analyzed LDA use in patients with UGIB (n=10,816) and controls without UGIB (n=30,519); one cohort study reported 207 UGIB cases treated with LDA only. All studies found LDA use to be associated with an increased risk of UGIB. The mean number of extra UGIB cases associated with LDA use in the RCTs was 1.2 per 1000 patients per year (95% CI 0.7 to 1.8). The number needed to harm was 816 (95% CI 560 to 1500) for RCTs and 819 (95% CI 617 to 1119) for observational studies. Meta-analysis of RCT data showed that LDA use was associated with a 50% increase in UGIB risk (OR 1.5 [95% CI 1.2 to 1.8]). UGIB risk was most pronounced in observational studies (OR 3.1 [95% CI 2.5 to 3.7]).Conclusions: LDA use was associated with an increased risk of UGIB.","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7000,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732153/pdf/cjg27159.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Gastroenterology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1155/2013/596015","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Low-dose acetylsalicylic acid (LDA, 75 mg/day to 325 mg/day) is recommended for primary and secondary prevention of cardiovascular events, but has been linked to an increased risk of upper gastrointestinal bleeding (UGIB).

Objective: To analyze the magnitude of effect of LDA use on UGIB risk.

Methods: The PubMed and Embase databases were searched for randomized controlled trials (RCTs) reporting UGIB rates in individuals receiving LDA, and observational studies of LDA use in patients with UGIB. Studies were pooled for analysis of UGIB rates.

Results: Eighteen studies were included. Seven RCTs reported UGIB rates in individuals randomly assigned to receive LDA (n=22,901) or placebo (n=22,923). Ten case-control studies analyzed LDA use in patients with UGIB (n=10,816) and controls without UGIB (n=30,519); one cohort study reported 207 UGIB cases treated with LDA only. All studies found LDA use to be associated with an increased risk of UGIB. The mean number of extra UGIB cases associated with LDA use in the RCTs was 1.2 per 1000 patients per year (95% CI 0.7 to 1.8). The number needed to harm was 816 (95% CI 560 to 1500) for RCTs and 819 (95% CI 617 to 1119) for observational studies. Meta-analysis of RCT data showed that LDA use was associated with a 50% increase in UGIB risk (OR 1.5 [95% CI 1.2 to 1.8]). UGIB risk was most pronounced in observational studies (OR 3.1 [95% CI 2.5 to 3.7]).

Conclusions: LDA use was associated with an increased risk of UGIB.

查看原文本刊更多论文

低剂量乙酰水杨酸的使用与上消化道出血风险：随机临床试验和观察性研究的荟萃分析。

背景：低剂量乙酰水杨酸（LDA，75 mg/天至325 mg/天）被推荐用于心血管事件的一级和二级预防，但与上消化道出血（UGIB）的风险增加有关。目的：分析使用LDA对UGIB风险的影响程度。方法：在PubMed和Embase数据库中搜索报告接受LDA的个体UGIB发病率的随机对照试验（RCT），以及UGIB患者使用LDA的观察性研究。对UGIB发病率进行汇总分析。结果：纳入18项研究。7项随机对照试验报告了随机分配接受LDA（n=22901）或安慰剂（n=22923）的个体的UGIB发生率。10项病例对照研究分析了UGIB患者（n=10816）和无UGIB对照组（n=30519）的LDA使用情况；一项队列研究报告了207例仅用LDA治疗的UGIB病例。所有研究都发现LDA的使用与UGIB风险的增加有关。随机对照试验中与LDA使用相关的额外UGIB病例的平均数为每年每1000名患者1.2例（95%CI 0.7至1.8）。随机对照试验所需的伤害数为816例（95%可信区间560至1500），观察性研究所需的危害数为819例（95%可信区间617至1119）。随机对照试验数据的荟萃分析显示，LDA的使用与UGIB风险增加50%有关（OR 1.5[95%CI 1.2至1.8]）。UGIB风险在观察性研究中最为显著（OR 3.1[95%CI 2.5至3.7]）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Canadian Journal of Gastroenterology 医学-胃肠肝病学

CiteScore

4.00

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Canadian Journal of Gastroenterology and Hepatology is a peer-reviewed, open access journal that publishes original research articles, review articles, and clinical studies in all areas of gastroenterology and liver disease - medicine and surgery. The Canadian Journal of Gastroenterology and Hepatology is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.