Prevention of Upper Gastrointestinal Ulcer and Complications in Low-Dose Aspirin Users

Low-dose aspirin (LDA) has been increasingly used worldwide to prevent atherothrombotic events. At the same time, the adverse events, most frequent of which are gastrointestinal (GI) ulcers and complications have been raising a big concern with its wider use. These adverse events including reflux and dyspeptic symptoms not only jeopardize adherence of LDA, but my cause more serious outcomes. To reduce GI events by informing best evidence for physicians prescribing LDA, guidelines were published some years ago. Since then, more clinical evidence concerning preventive strategies for upper GI events has been accumulated. Notable differences between East and West are also recognized in terms of primary prevention strategy. Among several options to provide cardiovascular protection with LDA while reducing GI risk, PPI co-therapy is considered to be preferred approach for wider populations according to recent cost-effectiveness analyses based on increasing awareness of importance on adherence of LDA together with declining cost of PPI. This review will focus on these new developments on the prevention of upper gastrointestinal ulcer and complications in LDA users.