GI-Safer Aspirin: Sometimes Sugar Coating Helps

Excerpt

Although aspirin in daily doses exceeding 325 mg is taken for its analgesic and anti-inflammatory effects, low-dose aspirin (LDA; daily dose 75–325 mg) is prescribed for its anti-platelet aggregation effects in the prevention of cardiovascular (CV) diseases associated with atherothrombotic disease. Since even a very low dose of aspirin (e.g., ~10 mg daily) can decrease the generation of protective prostaglandins (PGs) in the gastric mucosa, aspirin always carries the risk of gastrointestinal (GI) toxicity, ranging from mild upper GI distress to peptic ulcer disease and its complications. The risk of upper GI mucosal injury and hemorrhage with aspirin is increased with older age, higher doses, previous ulcer history, male sex, and concomitant use of non-aspirin non-steroidal anti-inflammatory drug (NSAIDs), corticosteroids, or other anti-thrombotic agents. Though in some patients, the CV benefits of LDA might be overshadowed by the risk of GI complications, in others, withdrawal of aspirin therapy can precipitate a fatal event. Therefore, although its GI risk is real, aspirin is one of the most commonly prescribed drugs worldwide with enormous clinical impact. Consequently, physicians always need to weigh the potential benefits and harms for each patient for whom an aspirin regimen is prescribed [1]. …