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Patterns in the Use of Low-Dose Acetylsalicylic Acid and Other Therapies Following Upper Gastrointestinal Bleeding

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Abstract

Background

Anticoagulants and/or antiplatelet agents such as acetylsalicylic acid (ASA) are important in prevention of cardiovascular (CV) events, but may be associated with upper gastrointestinal bleeding (UGIB). However, discontinuing these agents may leave patients at risk of CV events.

Objectives

This study aimed to assess patterns of therapy after UGIB in routine clinical practice.

Methods

The Health Improvement Network UK primary care database was used to identify a cohort of patients aged 40–84 years with a UGIB event between 2000 and 2007 (n = 2,036). Patients were followed up for 1 year from the recorded UGIB. Re-prescription rates for antithrombotics and drugs that can modify the risk of UGIB were estimated at 30, 90, 180, and 365 days.

Results

At 365 days, the re-prescription rate was 43 % for ASA, 66 % for warfarin, 69 % for clopidogrel, and 49 % for dipyridamole. The re-prescription rate of gastroprotective agents at 365 days for current users of histamine H2-receptor antagonists was 36 % and that of proton pump inhibitors (PPIs) was 97 %. In patients who were prescribed ASA before UGIB (n = 572), only 24 % were prescribed a PPI in the previous year. In patients who were prescribed ASA in the year after UGIB (n = 337), 92 % were prescribed a PPI.

Conclusions

Antiplatelet use fell after UGIB events. In patients who were prescribed a PPI after a UGIB event, there was increased re-prescription of antiplatelet agents and antithrombotics.

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Acknowledgments

The study was funded in part by AstraZeneca R&D, Mölndal, Sweden. Writing support was provided by Dr Rowan Pearce of Oxford PharmaGenesis™ Ltd and funded by AstraZeneca R&D, Mölndal, Sweden.

Conflict of interest statement

María E. Sáez, Antonio González-Pérez, and Luis A. García Rodríguez are employees of the Spanish Centre for Pharmacoepidemiologic Research (CEIFE), which has received research funding from AstraZeneca R&D, Mölndal, Sweden, and Bayer Pharma AG, Berlin, Germany. Luis A. García Rodríguez has also served as a speaker and an advisory board member for AstraZeneca R&D, Mölndal, Sweden, and Bayer Pharma AG, Berlin, Germany. Saga Johansson and Péter Nagy are employees of AstraZeneca R&D, Mölndal, Sweden.

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Authors and Affiliations

  1. Spanish Centre for Pharmacoepidemiologic Research (CEIFE), c/Almirante 28, 2°, 28004, Madrid, Spain

    María E. Sáez, Antonio González-Pérez & Luis A. García Rodríguez

  2. Andalusian Bioinformatics Research Center (CAEBi), Seville, Spain

    María E. Sáez & Antonio González-Pérez

  3. AstraZeneca R&D, Mölndal, Sweden

    Saga Johansson & Péter Nagy

Authors
  1. María E. Sáez
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  2. Antonio González-Pérez
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  5. Luis A. García Rodríguez
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Correspondence to Luis A. García Rodríguez.

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Sáez, M.E., González-Pérez, A., Johansson, S. et al. Patterns in the Use of Low-Dose Acetylsalicylic Acid and Other Therapies Following Upper Gastrointestinal Bleeding. Am J Cardiovasc Drugs 14, 443–450 (2014). https://doi.org/10.1007/s40256-014-0088-x

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  • DOI: https://doi.org/10.1007/s40256-014-0088-x

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