Risk for Low-Dose Aspirin-Associated Peptic Ulcer Higher in Elderly Women
By Laurie Barclay, MD
Medscape Medical News
April 28, 2010 — The risk for low-dose aspirin (LDA)–associated peptic ulcer is higher in elderly women, according to the results of a study reported in the April 21 issue of World Journal of Gastroenterology.
"...LDA is one of the main agents used for the prevention of thromboembolic vascular events, and has the advantages of both low cost and a prolonged duration of antiplatelet action; however, it is associated with a doubling of the risk of gastrointestinal bleeding, even at doses as low as 75 mg daily," write Kazuhisa Okada, from Hiratsuka City Hospital in Hiratsuka, Japan, and colleagues. "The gender differences in the clinical manifestations of LDA-associated gastroduodenal mucosal injury have not been well studied. The aim of this study was to clarify the clinical features and risk factors of LDA-associated gastroduodenal mucosal injury in both sexes."
Between January 2003 and December 2007, a total of 453 patients (298 men and 155 women) being treated with LDA (81 - 100 mg daily) underwent esophagogastroduodenoscopy at Hiratsuka City Hospital and continued taking LDA during the entire observation period. LDA-associated peptic ulcer was diagnosed in 119 patients (87 men and 32 women).
In both sexes, a history of peptic ulcer was a risk factor for LDA-associated peptic ulcer. Another significant risk factor in women, but not in men, was age older than 70 years (prevalence odds ratios, 8.441; 95% confidence interval, 1.797 - 33.649; P = .0069). Compared with male patients, female patients had a significantly shorter time to diagnosis of LDA-associated peptic ulcer by endoscopy (P = .0050).
"We demonstrated gender differences about the clinical features and risk factors of LDA-associated peptic ulcer," the study authors write. "Special attention should be paid to aged female patients taking LDA."
Limitations of this study include observational design.
"In female patients of advanced age, the gradual decrease in the serum levels of female sex hormones after menopause and with advancing age, coupled with the reduced gastric mucosal defenses may be responsible for the increase in the risk of LDA-associated peptic ulcer," the study authors conclude.