Can acetylsalicylic acid (Aspirin) cause a gastrointestinal (GI) bleed?

From the Guidelines

Yes, aspirin can cause gastrointestinal (GI) bleeding, as evidenced by a study published in 2018 1, which suggests that even low-dose aspirin (75-100 mg daily) can increase the risk of GI bleeding, particularly when combined with other medications such as oral anticoagulants. The risk of GI bleeding associated with aspirin use is a significant concern, especially in certain populations such as older adults, those with a history of GI bleeding or ulcers, and individuals taking other medications that increase the risk of bleeding, such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or anticoagulants. Some key factors that increase the risk of GI bleeding with aspirin use include:

• Higher doses of aspirin
• Longer duration of use
• Age over 65
• History of previous GI bleeding or ulcers
• Concurrent use of other NSAIDs, corticosteroids, or anticoagulants
• Alcohol consumption To minimize the risk of GI bleeding, strategies such as taking aspirin with food, using enteric-coated formulations, or adding a proton pump inhibitor for stomach protection may be considered, as suggested by a study published in 2010 1. It is essential to weigh the potential benefits of aspirin therapy against the risks of GI bleeding and to discuss these risks with a healthcare provider, particularly for individuals with a high risk of bleeding or those who require long-term aspirin therapy, as recommended by the U.S. Preventive Services Task Force 1.

From the FDA Drug Label

Stomach bleeding warning: This product contains an NSAID, which may cause severe stomach bleeding You experience any of the following signs of stomach bleeding: feel faint, vomt blood, have bloody or black stools, have stomach pain that does not get better

Yes, aspirin can cause a GI bleed, as stated in the warnings section of the drug label 2 and further described in the stop use and ask a doctor section of another label 2.

• The chance of stomach bleeding is higher in certain individuals, such as those age 60 or older, with a history of stomach ulcers or bleeding problems, or taking other medications like blood thinners or steroids.
• Signs of stomach bleeding include feeling faint, vomiting blood, bloody or black stools, and stomach pain that does not get better.

From the Research

Aspirin and GI Bleed Risk

• Aspirin use is associated with an increased risk of gastrointestinal bleeding, including both upper and lower GI bleeding 3, 4, 5, 6, 7
• The risk of upper gastrointestinal bleeding with aspirin is increased with old age, male sex, ulcer history, and concomitant medication with NSAIDs, cyclooxygenase 2 selective inhibitors, corticosteroids, or other antithrombotic agents 3
• Low-dose aspirin users have a higher incidence of lower gastrointestinal bleeding (LGIB) than non-users, with a hazard ratio of 2.75 6
• Aspirin use is an independent predictor of rebleeding, but it also protects against cardiovascular events and death 7

Factors Influencing GI Bleed Risk

• Concomitant use of other medications, such as NSAIDs, steroids, and anticoagulants, can increase the risk of GI bleeding in aspirin users 5, 6
• Eradication of Helicobacter pylori infection and concurrent proton pump inhibitor therapy may help reduce the risk of gastrointestinal toxicity in patients taking aspirin 3, 4
• Use of proton pump inhibitors is associated with reduced risk of upper, but not lower, gastrointestinal bleeding 5

Clinical Considerations

• Physicians should consider the benefits and harms of aspirin therapy for each individual patient, taking into account their risk factors for GI bleeding and cardiovascular events 3, 7
• Aspirin users with a history of lower GI bleeding should be closely monitored for recurrent bleeding and cardiovascular events 7