Aspirin is widely used as an antiplatelet drug for the secondary prevention of cardiovascular event in patients with myocardial infarction. However, gastrointestinal complications (ulceration, bleeding, perforation) as adverse drug reactions may also be associated with aspirin use. Low-dose aspirin is very widely used for the secondary prevention of cardiovascular event that clinicians may not be aware of gastrointestinal complications. We report 5 patients with gastrointestinal bleeding associated with low-dose aspirin for the prevention of cardiovascular events.
All 5 patients were males, and the mean age was 68 ± 9.6 years. They had been treated with low-dose aspirin (81mg daily) from 17 days-2 years. At hospital admission, all patients had severe anemia, and complained of anorexia, tarry stool, melena, and light-headedness, but none reported stomachache. A gastroendoscopic examination showed active A 1 stage ulcers in four patients, and an active A 2 stage ulcer in one patient. Endoscopic hemostatic procedures were performed in four patients. In all patients, the gastrointestinal complications improved after the administration of proton pump inhibitor and the discontinuation of aspirin.
Although every patient had been administered low-dose aspirin (81mg daily), severe gastrointestinal bleeding which required hospitalization developed in all 5 patients. They did not complain of pain, and their hemorrhagic ulcers were suspected to be due to severe anemia or melena. Their symptoms were consistent with the features of “silent ulcer” associated with aspirin or other nonsteroidal antiinflammatory drugs. All but one patient was elderly and more than 60 years of age. In 3 patients, hemorrhagic ulcers developed within 2 months after aspirin initiation. Therefore, gastrointestinal bleeding associated with aspirin does not necessary occur only after long term use.
When aspirin is used for the secondary prevention of cardiovascular events in patients with myocardial infarction, the risk of gastrointestinal bleeding can not be ruled out even with low-dose administration. Especially for elderly patients, clinicians should therefore include such a possibility in the follow-up of such patients.
