Low-Dose Acetylsalicylic Acid and the Use of Gastroprotectors among Older Adults

Neeraj Bhala, MBChB, MRCP, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Clinical Medicine, Oxford, UK.
Angel Lanas, MD, PhD, Service of Gastroenterology, Instituto Aragones de Ciencias de la Salud, University Hospital, CIBERehd. Zaragoza, Spain.

Low-dose acetylsalicylic acid (ASA) is widely used in the prevention of cardiovascular events but can be associated with upper gastrointestinal (GI) complications, including ulcers. In this article, the range of effects of GI toxicity and the epidemiology of ASA-associated events are discussed, as well as risk factors, such as increasing age, that predict bleeding. Strategies to minimize upper GI events in older adults include the use of mucosal protectants such as proton pump inhibitors. The use of alternative antiplatelet agents including clopidogrel or Helicobacter pylori infection eradication may not provide sufficient protection in at-risk individuals who need low-dose ASA.
Key words: low-dose ASA, upper gastrointestinal events, older adults, gastroprotection, proton pump inhibitor.