PMID- 15478856
OWN - NLM
STAT- MEDLINE
DCOM- 20041104
LR  - 20190627
IS  - 0002-9343 (Print)
IS  - 0002-9343 (Linking)
VI  - 117 Suppl 5A
DP  - 2004 Sep 6
TI  - Cardioprotective effects and gastrointestinal risks of aspirin: maintaining the 
      delicate balance.
PG  - 72S-78S
AB  - Aspirin is a very useful medication for the prevention of cardiovascular 
      thrombotic events in patients with or those at risk for cardiovascular disease 
      (CVD). Aspirin, however, carries an increased risk for gastrointestinal (GI) 
      injury (e.g., ulceration) and its complications (e.g., hemorrhage), which may be 
      caused by its antiplatelet and gastric mucosal effects. In those with established 
      CVD, aspirin use has been documented to decrease the risk of a first myocardial 
      infarction (MI). Its effects on stroke and vascular death are less conclusive. 
      The use of aspirin in these individuals is recommended only for those whose risk 
      for cardiovascular events (based on coronary risk assessment tools) is 
      sufficiently high that it outweighs the risk for GI complications. Secondary 
      prevention refers to the use of aspirin to prevent cardiovascular events in 
      patients with established CVD such as an MI, stroke, or angina. The use of 
      aspirin in these individuals is recommended based on a documented decrease in 
      future cardiovascular events and mortality. The risk for GI events with aspirin 
      is at least additive to the risk for these events in those who also are receiving 
      therapy with a nonsteroidal anti-inflammatory drug. Patients being treated with 
      aspirin, even at 81 mg/day for cardioprotection, should be assessed for factors 
      that increase the risk for GI injury. Studies have confirmed that co-therapy with 
      a proton pump inhibitor (PPI) or misoprostol decreases the risk for GI injury and 
      complications. Although both classes of such gastroprotective agents are 
      effective, treatment with a PPI is tolerated better, with fewer patients 
      discontinuing the drug because of side effects such as diarrhea.
FAU - Kimmey, Michael B
AU  - Kimmey MB
AD  - Division of Gastroenterology, University of Washington, School of Medicine, 
      Seattle, Washington 98195, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Am J Med
JT  - The American journal of medicine
JID - 0267200
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Proton Pump Inhibitors)
RN  - 0 (Proton Pumps)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Aged
MH  - Anti-Ulcer Agents/administration & dosage
MH  - Aspirin/*adverse effects/*therapeutic use
MH  - Cardiovascular Diseases/*prevention & control
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Female
MH  - Gastrointestinal Diseases/*chemically induced/*drug therapy/epidemiology
MH  - Gastrointestinal Hemorrhage/chemically induced/drug therapy/epidemiology
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Primary Prevention/methods
MH  - Prognosis
MH  - *Proton Pump Inhibitors
MH  - Proton Pumps/administration & dosage
MH  - Risk Assessment
MH  - Stomach Ulcer/chemically induced/drug therapy/epidemiology
RF  - 35
EDAT- 2004/10/14 09:00
MHDA- 2004/11/05 09:00
CRDT- 2004/10/14 09:00
PHST- 2004/10/14 09:00 [pubmed]
PHST- 2004/11/05 09:00 [medline]
PHST- 2004/10/14 09:00 [entrez]
AID - S1548-2766(04)00012-3 [pii]
AID - 10.1016/j.amjmed.2004.07.012 [doi]
PST - ppublish
SO  - Am J Med. 2004 Sep 6;117 Suppl 5A:72S-78S. doi: 10.1016/j.amjmed.2004.07.012.