Gastroduodenal ulcer bleeding in elderly patients on low dose aspirin therapy

World J Gastroenterol. 2018 Sep 14;24(34):3908-3918. doi: 10.3748/wjg.v24.i34.3908.

Abstract

Aim: To determine the clinical characteristics of elderly patients of hemorrhagic gastroduodenal ulcer on low-dose aspirin (LDA) therapy.

Methods: A total of 1105 patients with hemorrhagic gastroduodenal ulcer treated in our hospital between January 2000 and March 2016 were grouped by age and drugs used, and these groups were compared in several factors. These groups were compared in terms of length of hospital stay, presence/absence of hemoglobin (Hb) decrease, presence/absence of blood transfusion, Forrest I, percentage of Helicobacter pylori infection, presence/absence of underlying disease, and percentage of severe cases.

Results: The percentage of blood transfusion (62.6% vs 47.7 %, P < 0.001), Hb decrease (53.8% vs 40.8%, P < 0.001), and the length of hospital stay (23.5 d vs 16.7 d, P < 0.001) were significantly greater in those on drug therapy. The percentage of blood transfusion (65.3% vs 47.8%, P < 0.001), Hb decrease (54.2% vs 42.1%, P < 0.001), and length of hospital stay (23.3 d vs 17.5 d, P < 0.001) were significantly greater in the elderly. In comparison with the LDA monotherapy group, the percentage of severe cases was significantly higher in the LDA combination therapy group when elderly patients were concerned (16.1% vs 34.0%, P = 0.030). Meanwhile, among those on LDA monotherapy, there was no significant difference between elderly and non-elderly (16.1% vs 16.0%, P = 0.985).

Conclusion: A combination of LDA with antithrombotic drugs or non-steroidal anti-inflammatory drugs (NSAIDs) contributes to aggravation. And advanced age is not an aggravating factor when LDA monotherapy is used.

Keywords: Antithrombotic drugs; Elderly patients; Hemorrhagic gastroduodenal ulcer; Low-dose aspirin; Proton pump inhibitor.

Publication types

  • Comparative Study

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Aspirin / adverse effects*
  • Cerebrovascular Disorders / prevention & control
  • Drug Therapy, Combination / adverse effects
  • Drug Therapy, Combination / methods
  • Female
  • Fibrinolytic Agents / adverse effects*
  • Helicobacter Infections / complications
  • Helicobacter Infections / epidemiology
  • Helicobacter Infections / microbiology
  • Helicobacter pylori / isolation & purification
  • Humans
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Myocardial Ischemia / prevention & control
  • Peptic Ulcer Hemorrhage / epidemiology*
  • Peptic Ulcer Hemorrhage / etiology
  • Retrospective Studies
  • Risk Factors
  • Stomach Ulcer / chemically induced
  • Stomach Ulcer / complications*

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Fibrinolytic Agents
  • Aspirin