Underutilization of gastroprotective strategies in aspirin users at increased risk of upper gastrointestinal complications

Aliment Pharmacol Ther. 2008 Jul;28(1):88-96. doi: 10.1111/j.1365-2036.2008.03713.x. Epub 2008 Apr 13.


Background: Aspirin use is with an increased risk of upper gastrointestinal complications (UGICs). Proton pump inhibitors (PPIs) decrease the risk of UGICs among aspirin users. The distribution of risk factors for UGIC and PPI utilization among aspirin users remains uncharacterized.

Aim: To determine the prevalence and predictors of PPI use in high-risk aspirin users.

Methods: Using questionnaires and administrative records, we collected information on aspirin and PPI utilization and risk factors for UGICs from a stratified random sample of subjects with established cardiovascular disease. We calculated the proportion of aspirin users with UGIC risk factors and determined the prevalence of PPI use among aspirin users with risk factors. Regression analysis was used to determine predictors of PPI use among aspirin users.

Results: Overall response rate was 35%, of whom 86% were regular aspirin users. Seventy-one per cent of aspirin users had at least one risk factor (in addition to cardiac disease) for the development of UGICs. Although a history of UGIC was predictive of PPI use, 44% of aspirin users with a prior history of UGICs did not receive a concomitant PPI, and only 23% of subjects with additional UGIC risk factors were prescribed a PPI.

Conclusion: There is a high prevalence of UGIC risk factors among aspirin users, and many are not prescribed PPIs as a gastroprotective strategy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Aspirin / administration & dosage
  • Aspirin / adverse effects*
  • Cardiovascular Diseases / prevention & control*
  • Drug Therapy, Combination
  • Female
  • Humans
  • Male
  • Peptic Ulcer / chemically induced*
  • Platelet Aggregation Inhibitors / administration & dosage
  • Platelet Aggregation Inhibitors / adverse effects*
  • Proton Pump Inhibitors / therapeutic use*
  • Risk Factors
  • Surveys and Questionnaires


  • Anti-Inflammatory Agents, Non-Steroidal
  • Platelet Aggregation Inhibitors
  • Proton Pump Inhibitors
  • Aspirin