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Incidences, temporal trends and risks of hospitalization for gastrointestinal bleeding in new or chronic low-dose aspirin users after treatment for helicobacter pylori: a territory-wide cohort study

Guo, C-G; Cheung, KS; Zhang, F; Chan, EW; Chen, L; Wong, I; Leung, WK; (2019) Incidences, temporal trends and risks of hospitalization for gastrointestinal bleeding in new or chronic low-dose aspirin users after treatment for helicobacter pylori: a territory-wide cohort study. Gut (In press). Green open access

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Abstract

Objective: The risk of gastrointestinal bleeding (GIB) in aspirin users after H. pylori (HP) eradication remains poorly defined. We characterized the incidences and temporal trends of hospitalizations for all GIB in aspirin users after HP eradication therapy. Design: Based on a territory-wide health database, we identified all patients who had received the first course of clarithromycin-based triple therapy between 2003 and 2012. Patients were divided into three cohorts according to aspirin use: new users (commenced after HP eradication), chronic users (commenced before and resumed after HP eradication) and non-users. The primary outcome was to determine the risk of hospitalization for GIB. Results: We included 6,985 new aspirin users, 5,545 chronic users, and 48,908 non-users. The age- and sex-adjusted incidence of hospitalization for all GIB in new, chronic and non-users was 10.4, 7.2 and 4.6 per 1000 person-years, respectively. Upper and lower GIB accounted for 34.7% and 45.3% of all bleeding, respectively. Compared to chronic users, new users had a higher risk of GIB (hazards ratio [HR] with propensity score matching: 1.89; 95% CI 1.29-2.70). Landmark analysis showed that the increased risk in new aspirin users was only observed in the first 6-month for all GIB (HR 2.10, 95% CI 1.41-3.13) and upper GIB (HR 2.52, 95% CI 1.38-4.60), but not for lower GIB. Conclusion: New aspirin users had a higher risk of GIB than chronic aspirin users, particularly during the initial 6-month. Lower GIB is more frequent than UGIB in aspirin users who had HP eradicated.

Type: Article
Title: Incidences, temporal trends and risks of hospitalization for gastrointestinal bleeding in new or chronic low-dose aspirin users after treatment for helicobacter pylori: a territory-wide cohort study
Open access status: An open access version is available from UCL Discovery
Publisher version: https://gut.bmj.com/
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy
URI: https://discovery.ucl.ac.uk/id/eprint/10073542
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