From the Guidelines
Yes, aspirin can cause gastrointestinal (GI) bleeds, and the risk is dose-dependent, with higher doses causing greater risk. Aspirin, even at low doses, increases the risk of GI bleeding by inhibiting the production of protective prostaglandins in the stomach lining and interfering with blood clotting mechanisms, as noted in a study published in the Journal of Clinical Gastroenterology and Hepatology 1. This dual effect makes the stomach more vulnerable to acid damage while simultaneously impairing the body's ability to stop bleeding if it occurs.
Risk Factors for GI Bleeding
The risk of GI bleeding is increased in:
- Older adults
- Those with a history of GI bleeding
- People taking other blood thinners or NSAIDs
- Those who consume alcohol regularly A study published in the journal Chest found that the relative risks of upper-GI bleeding for plain, enteric-coated, and buffered aspirin at average daily doses of 325 mg were 2.6,2.7, and 3.1, respectively 1.
Reducing the Risk of GI Bleeding
To reduce this risk while taking aspirin, patients should:
- Take it with food
- Consider enteric-coated formulations
- Use the lowest effective dose
- Avoid combining with other NSAIDs
- Discuss with their doctor about adding a proton pump inhibitor for protection if they're at high risk for GI complications, as suggested by a study published in the American Family Physician 1.
Important Considerations
It's essential to weigh the benefits of aspirin therapy against the potential harms, particularly in older adults or those with a history of GI bleeding, as noted in a study published in the Annals of Internal Medicine 1. Clinicians should inform patients about the adverse consequences of gastrointestinal bleeding and discuss the potential benefits and harms of aspirin therapy.
Key Takeaways
- Aspirin can cause GI bleeds, even at low doses
- The risk is dose-dependent and increased in certain populations
- Patients should take steps to reduce their risk, such as taking aspirin with food and using the lowest effective dose
- Clinicians should discuss the potential benefits and harms of aspirin therapy with patients, particularly those at high risk for GI complications, as recommended by a study published in the Annals of Internal Medicine 1, 1, and 1.
From the FDA Drug Label
Stomach bleeding warning: This product contains an NSAID, which may cause severe stomach bleeding The chance is higher if you are age 60 or olderHave had stomach ulcers or bleeding problemsTake a blood thinning (Anticogulant) or steroid drugTake other drugs containing prescription or nonprescription NSAIDs (aspirin, ibuprofen, naproxen, or others)have 3 or more alcoholic drinks every day using this product Yes, aspirin can cause GI bleeds. The risk is increased in certain individuals, including:
- Those age 60 or older
- Those with a history of stomach ulcers or bleeding problems
- Those taking blood thinning or steroid drugs
- Those taking other NSAIDs
- Those who consume 3 or more alcoholic drinks per day 2
From the Research
Aspirin and GI Bleeds
- Aspirin can cause gastrointestinal (GI) bleeds, even at low doses 3, 4
- The risk of GI bleeding is increased with the use of antiplatelet medications, including aspirin 5
- Concomitant use of aspirin and nonaspirin NSAIDs or COX-2 inhibitors can significantly increase the risk of GI ulceration and bleeding 3, 6
- Risk factors for gastrointestinal bleeding associated with low-dose aspirin include:
- History of peptic ulcer disease or gastrointestinal bleeding
- Older age
- Concomitant use of NSAIDs, including coxibs
- Concomitant use of anticoagulants or other platelet aggregation inhibitors
- Presence of severe co-morbidities
- High aspirin dose 6
- Continuation of aspirin after an episode of lower GI bleeding is associated with an increased risk of recurrent lower GI bleeding, but reduced risk of serious cardiovascular events and death 7