ASPIRINA EN DOSIS BAJAS Y COMPLICACIONES GASTROINTESTINALES





ASPIRINA EN DOSIS BAJAS Y COMPLICACIONES GASTROINTESTINALES

(especial para SIIC © Derechos reservados)
El riesgo de hemorragia gastrointestinal en pacientes que consumen aspirina parece ser dependiente de la dosis, aunque menor que el observado en los que utilizan antiinflamatorios no esteroides.
lanas9.jpg Autor:
Angel Lanas Arbeloa
Columnista Experto de SIIC

Institución:
Jefe de Sección Aparato Digestivo Hospital Clínico "Lozano Blesa"


Artículos publicados por Angel Lanas Arbeloa
Coautor
Angel Ferrández Arenas* 
Doctor en Medicina y Cirugía. Hospital Clínico Universitario de Zaragoza e Instituto Aragonés de Ciencias de la Salud.*
Recepción del artículo
20 de Diciembre, 2004
Aprobación
7 de Febrero, 2005
Primera edición
26 de Agosto, 2005
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La utilización de aspirina se asocia con incremento significativo de hemorragia gastrointestinal. Dicho riesgo parece ser dependiente de la dosis y, aunque es menor que el observado para antiinflamatorios no esteroides clásicos, no parece existir una dosis libre de riesgo. Los factores de riesgo no están totalmente definidos aunque la historia previa de úlcera o complicaciones y la infección por Helicobacter pylori parecen ser los más importantes. Si bien la información al respecto continúa siendo escasa debería ofrecerse profilaxis a aquellos pacientes con uno o más factores de riesgo o a aquellos pacientes que presentando mala salud requieran aspirina. Aunque la terapia profiláctica ideal está todavía por definirse, la mejor opción para la profilaxis parecen ser los inhibidores de la bomba de protones, especialmente beneficiosa en los pacientes de alto riesgo. La erradicación de la infección por H. pylori podría ser otra alternativa en la profilaxis aunque hacen falta más estudios que aclaren su papel exacto y en qué población debe aplicarse.

Palabras clave
Hemorragia gastrointestinal, aspirina, úlcera péptica, Helicobacter pylori, antiinflamatorios no esteroides


Artículo completo

(castellano)
Extensión:  +/-7.01 páginas impresas en papel A4
Exclusivo para suscriptores/assinantes

Abstract
The use of aspirin is associated with a significant increase of gastrointestinal bleeding. This risk appears to be dose-dependent and although it is lower than the one observed with classical NSAIDS there is no risk-free dose. Risk factors are poorly described, although a previous history of peptic ulcer or complications as well as Helicobacter pylori infection seem to be the most relevant ones. Patients with one or more risk factors or those with poor health conditions requiring aspirin, should receive prophylaxis, although data concerning such issues is still scarce. The ideal prophylactic strategy has yet to be defined but proton pump inhibitors are the best option available and they are very beneficial in high-risk patients. H. pylori eradication could be a reasonable prophylactic alternative but more studies are needed to clarify the exact role H. pylori has and the population that would benefit from eradication.

Key words
Gastrointestinal bleeding, aspirin, peptic ulcer, Helicobacter pylori, nsaids


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Alergia, Gastroenterología
Relacionadas: Atención Primaria, Cardiología, Farmacología, Hematología, Medicina Farmacéutica, Medicina Interna



Comprar este artículo
Extensión: 7.01 páginas impresas en papel A4

file05.gif (1491 bytes) Artículos seleccionados para su compra



Bibliografía del artículo
  1. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high-risk patients. BMJ 2002; 324:71-86.
  2. Stafford RS. Aspirin use is low among United States outpatients with coronary artery disease. Circulation 2000; 101:1097-1101.
  3. Weisman SM, Graham DY. Evaluation of the benefits and risks of low-dose aspirin in the secondary prevention of cardiovascular and cerebrovascular events. Arch Intern Med 2002; 162:2197-202.
  4. Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Ascherio A, Willett WC:Aspirin use and the risk for colorectal cancer and adenoma in male health professionals. Ann Intern Med 1994; 121:241-246.
  5. Langman MJ, Cheng KK, Gilman EA, Lancashire RJ. Effect of anti-inflammatory drugs on overall risk of common cancer: case-control study in general practice research database. BMJ 2000; 320:1642-1646.
  6. Thun MJ. Aspirin and gastrointestinal cancer Adv Exp Med Biol 1997; 400A:395-402.
  7. Beard CM, Waring SC, O'Brien PC, Kurland LT, Kokmen E. Nonsteroidal anti-inflammatory drug use and Alzheimer's disease: a case-control study in Rochester, Minnesota, 1980 through 1984. Mayo Clin Proc 1998; 73:951-5.
  8. Baron JA, Cole BF, Sandler RS, Haile RW, Ahnen D, Bresalier R, McKeown-Eyssen G, Summers RW, Rothstein R, Burke CA, Snover DC, Church TR, Allen JI, Beach M, Beck GJ, Bond JH, Byers T, Greenberg ER, Mandel JS, Marcon N, Mott LA, Pearson L, Saibil F, van Stolk RU. A randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med 2003; 348:891-9.
  9. Sandler RS, Halabi S, Baron JA, Budinger S, Paskett E, Keresztes R, Petrelli N, Pipas JM, Karp DD, Loprinzi CL, Steinbach G, Schilsky R. A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med 2003; 348:883-90.
  10. Friis S, Sorensen HT, McLaughlin JK, Johnsen SP, Blot WJ, Olsen JH. A population-based cohort study of the risk of colorectal and other cancers among users of low-dose aspirin. Br J Cancer 2003; 88:684-8
  11. Boltri JM, Akerson MR, Vogel RL. Aspirin prophylaxis in patients at low risk for cardiovascular disease: a systematic review of all-cause mortality. J Fam Pract 2002; 51:700-4.
  12. Simon B, Elsner H, Muller P. Protective effect of omeprazole against low-dose acetylsalicylic acid. Endoscopic controlled double-blind study in healthy subjects. Arzneimittelforschung 1995; 45:701-703.
  13. Muller P, Fuchs W, Simon B. Studies on the protective effect of lansoprazole on human gastric mucosa against low-dose acetylsalicylic acid. An endoscopic controlled double-blind study. Arzneimittelforschung 1997; 47:758-760.
  14. Kordecki H, Kurowski M, Kosik M, Pilecka D. Is Helicobacter pylori infection a risk or protective factor for mucosal lesions development in patients chronically treated with acetylsalicylic acid J Physiol Pharmacol 1997; 48:85-91.
  15. Chowdhury A, Ganguly G, Chowdhury D, Santra A, Gupta JD, Roy T. Gastro-duodenal mucosal changes associated with low-dose aspirin therapy: a prospective, endoscopic study. Indian J Gastroenterol 2001; 20:227-9.
  16. Prichard PJ, Kitchingman GK, Walt RP, Daneshmend TK, Hawkey CJ. Human gastric mucosal bleeding induced by low dose aspirin, but not warfarin. Br Med J 1989; 298:493-496.
  17. Kitchingman GK, Prichard PJ, Daneshmend TK, Walt RP, Hawkey CJ. Enhanced gastric mucosal bleeding with doses of aspirin used for prophylaxis and its reduction by ranitidine. Br J Clin Pharmacol 1989; 28:581-585.
  18. Goldstein JL, Agrawal NM, Silverstein FE, Verburg KM, Burr AM, Hubbard RC et al. Influence of H. pylori (HP) infection and/or low dose aspirin (ASA) on gastroduodenal ulceration in patients treated with placebo, celecoxib or NSAIDs. Gastroenterology 1999; 116:A174.
  19. Cryer B, Feldman M. Effects of very low dose daily, long-term aspirin therapy on gastric, duodenal, and rectal prostaglandin levels and on mucosal injury in healthy humans. Gastroenterology 1999; 117:17-25.
  20. Slattery J, Warlow CP, Shorrock CJ, Langman MJ. Risks of gastrointestinal bleeding during secondary prevention of vascular events with aspirin-analysis of gastrointestinal bleeding during the UK-TIA trial. Gut 1995; 37:509-511.
  21. Weil J, Colin-Jones D, Langman MJS, Lawson D, Logan R, Murphy M, Rawlins M, Vessey M, Wainwright P. Prophylactic aspirin and risk of peptic ulcer bleeding. BMJ 1995; 310:827-830.
  22. Serrano P, Lanas A, Arroyo M, Casanovas JA, Ferreira I. Risk stratification of upper gastrointestinal bleeding in cardiovascular patients on low dose aspirin: a cohort study. Gastroenterology 2000; 118:A194.
  23. Lanas A, Bajador E, Serrano P, Fuentes J, Carreño S, Guardia J, Sainz R. Nitrovasodilators, low-dose aspirin, nonsteroidal anti-inflammatory drugs, and the risk of upper gastrointestinal bleeding. N Engl J Med 2000; 343:834-839.
  24. García Rodríguez LA, Hernández-Díaz S, de Abajo FJ. Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies. Br J Clin Pharmacol 2001; 52:563-71.
  25. Serrano P, Lanas A, Arroyo MT, Ferreira IJ. Risk of upper gastrointestinal bleeding in patients taking low-dose aspirin for the prevention of cardiovascular diseases. Aliment Pharmacol Ther 2002; 16 (11):1945-53.
  26. Lanas A, Fuentes J, Benito R, Serrano P, Bajador E, Sainz R. Helicobacter pylori increases the risk of upper gastrointestinal bleeding in patients taking low-dose aspirin. Aliment Pharmacol Ther 2002; 16:779-86.
  27. Silverstein FE, Graham DY, Senior JR, Davies HW, Struthers BJ, Bittman RM, Geis GS. Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal anti-inflammatory drugs. A randomized, doubleblind, placebo-controlled trial. Ann Intern Med 1995; 123:241- 249.
  28. MacDonald TM, Wei L. Effect of ibuprofen on cardioprotective effect of aspirin. Lancet 2003; 361 (9357):573-4.
  29. De Abajo FJ, García Rodríguez LA. Risk of upper gastrointestinal bleeding and perforation associated with low-dose aspirin as plain and enteric-coated formulations. BMC Clin Pharmacol 2001; 1:1.
  30. Derry S, Loke YK. Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis. BMJ 2000; 321 (7270):1183-7.
  31. Silagy CA, McNeil JJ, Donnan GA, Tonkin AM, Worsam B, Campion K. Adverse effects of low dose aspirin in healthy elderly population. Clin Pharmacol Ther 1993; 54:84-89.
  32. Van Hecken A, Juliano ML, Depre M, De Lepeleire I, Arnout J, Dynder A, Wildonger L, Petty KJ, Gottesdiener K, De Hoon JN. Effects of enteric-coated, low-dose aspirin on parameters of platelet function. Aliment Pharmacol Ther 2002; 16:1683-8.
  33. Kelly JP, Kaufman DW, Jurgelon JM, Sheehan J, Koff RS, Shapiro S. Risk of aspirin-associated major upper-gastrointestinal bleeding with enteric-coated or buffered product. Lancet 1996; 34:1413-1416.
  34. Stack WA, Atherton JC, Hawkey GM, Logan RF, Hawkey CJ. Interactions between Helicobacter pylori and other risk factors for peptic ulcer bleeding. Aliment Pharmacol Ther 2002; 16:497-506.
  35. Chan FKL, Chung SCS, Suen BY, Lee YT, Leung WK, Leung VKS, Wu JC, Lau JY, Hui Y, Lai MS, Chan HL, Sung JJ. Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen. N Engl J Med 2001; 344:967-973.
  36. Lai KM, Lam SK, Chu KM, Wong BCY, Hui WM, Hu WHC, Lau GKK, Wong WM, Yuen MF, Chan AOO, Lai CL, Wong J. Lansoprazole for the Prevention of Recurrences of Ulcer Complications from Long-Term Low-Dose Aspirin Use. N Engl J Med 2002; 346:2033-2038.
  37. Bianchi Porro G, Parente F, Imbesi V, Montrone F, Caruso I. Role of Helicobacter pylori in ulcer healing and recurrence of gastric and duodenal ulcers in longterm NSAID users. Response to omeprazole dual therapy. Gut 1996; 39:22-6.
  38. Aalykke C, Lauritsen JM, Hallas J, Reinholdt S, Krogfelt K, Lauritsen K. Helicobacter pylori and risk of ulcer bleeding among users of nonsteroidal anti-inflammatory drugs: a case-control study. Gastroenterology 1999; 116:1305-9.
  39. Santolaria S, Lanas A, Benito R, Perez-Aisa M, Montoro M, Sainz R. Helicobacter pylori infection is a protective factor for bleeding gastric ulcers but not for bleeding duodenal ulcers in NSAID users. Aliment Pharmacol Ther 1999; 13:1511-8.
  40. Lanas A, on behalf of the EMPHASIS study group. Low frequency of upper gastrointestinal complications in the high risk patient taking low-dose aspirin and omeprazole. Gastroenterology 2001; 120:A596.
  41. Chan FKL, Wu JCY, Suen BY, et al. Eradication of H. pylori to prevent recurrent ulcer complications associated with low-dose aspirin: a long-term cohort study. San Francisco DDW 2002:A696.
  42. Yeomans N, Tulassay Z, Juhasz L, Racz I, Howard JM, Van Rensburg CJ Swannell AJ, Hawkey CJ, for the Acid Suppression Trial: Ranitidine versus Omeprazole for NSAID-Associated ulcer treatment (ASTRONAUT). A comparison of omeprazole with ranitidine for ulcers associated with nonsteroidal antiinflammatory drugs. N Engl J Med 1998; 338:719-726.
  43. Hawkey CJ, Karrasch JA, Szczepanski L, Walker DG, Barkun A, Swwannell AJ, Yeomans ND, for the Omeprazole versus Misoprostol for NSAID-Induced Ulcer Management (OMNIUM) Study Group. Omeprazole compared with misoprostol for ulcers associated with nonsteroidal antiinflammatory drugs. N Engl J Med 1998; 338:727-734.
  44. Hawkey CJ, Lanas A, on behalf of the Sardinia NSAID meeting participants. Doubt and certainty about NSAIDs in the year 2000: a multidisciplinary expert statement. Am J Med 2001; 110:79S- 100S.
  45. Donelly MT, Goddard AF, Filipowicz B, Morant SV, Shield MJ, Hawkey CHJ. Low-dose misoprostol for the prevention of low-dose aspirin-induced gastroduodenal injury. Aliment Pharmacol Ther 2000; 14 (5):529-34.
  46. Iñarrea P, Esteva F, Cornudella R, Lanas A. Omeprazole does not interfere with the antiplatelet effect of low-dose aspirin in man. Scand J Gastroenterol 2000; 35:242-246.
  47. Muller P, Fuchs W, Simon B. Studies on the protective effect of lansoprazole on human gastric mucosa against low-dose acetylsalicylic acid. An endoscopic controlled double-blind study. Arzneimittelforschung 1997; 47:758-760.
  48. Kitchingman GK, Prichard PJ, Daneshmend TK, Walt RP, Hawkey J. Enhanced gastric mucosal bleeding with doses of aspirin used for prophylaxis and its reduction by ranitidine. Br J Clin Pharmacol 1989; 28:581-585.
  49. Hawkey CJ, Somerville KW, Marshall S. Prophylaxis of aspirin induced gastric mucosal bleeding with ranitidine. Aliment Pharmacol Ther 1988; 2:245-252.
  50. Napoli C, Ackah E, De Nigris F, Del Soldato P, D'Armiento FP, Crimi E, Condorelli M, Sessa WC. Chronic treatment with nitric oxide-releasing aspirin reduces plasma low-density lipoprotein oxidation and oxidative stress, arterial oxidation-specific epitopes, and atherogenesis in hypercholesterolemic mice. Proc Natl Acad Sci USA 2002; 99:12467-70.
  51. Fiorucci S, Santucci L, Gresele P, Faccino RM, Del Soldato P, Morelli A. Gastrointestinal safety of NO-aspirin (NCX-4016) in healthy human volunteers: a proof of concept endoscopic study. Gastroenterology 2003; 124: 600-7.

Título español
Resumen
 Palabras clave
 Bibliografía
 Artículo completo
(exclusivo a suscriptores)
 Autoevaluación
  Tema principal en SIIC Data Bases
 Especialidades

 English title
 Abstract
 Key words
Full text
(exclusivo a suscriptores)


Autor 
Artículos
Correspondencia

Patrocinio y reconocimiento
Imprimir esta página
 
 
 
 
 
 
 
 
 
 
 
 
Está expresamente prohibida la redistribución y la redifusión de todo o parte de los contenidos de la Sociedad Iberoamericana de Información Científica (SIIC) S.A. sin previo y expreso consentimiento de SIIC.
ua31618