Investigation of gastroduodenal mucosal injuries caused by low-dose aspirin therapy in patients with cerebral infarction

Background and Aims:  Low-dose aspirin is used as a preventive treatment for ischemic heart disease and ischemic cerebrovascular disease, on the other hand gastrointestinal injuries are an adverse effect of aspirin. We reported that endoscopic surveillance reveals a high risk of gastroduodenal ulcer and erosion in aspirin users of ischemic heart disease. But risk of gastroduodenal injuries may be different among pre-existing disease. In the present study, endoscopic examination was performed to investigate the frequency of gastroduodenal injuries associated with low-dose aspirin in patients with cerebrovascular disease. Methods:  Routine examination using upper gastrointestinal tract endoscopy was prospectively performed for all patients admitted to Sasson Hospital for rehabilitation after cerebral infarction from April 2005 to September 2007. Endoscopic findings such as ulcers and flat erosions were assessed as mucosal injuries. Results:  Endoscopic examination was performed for 142 successive patients, divided into three groups: 70 patients as low-dose aspirin users (aspirin group); 61 as non-aspirin users (non-aspirin group); and 11 as multi-drug users of aspirin plus other anti-platelet drugs (combination group). The aspirin group without anti-ulcer drugs (A- group) comprised 47 patients and the non-aspirin group without anti-ulcer drugs (NA- group) 31 patients. Mucosal injuries were detected in 29.8% of the A- group and in 6.4% of the NA- group (P < 0.05). The frequency of ulcer was similar between the A- group (6.4%) and NA- group (3.2%). Conclusion:  Endoscopy reveals low-dose aspirin-induced gastroduodenal injuries in patients with cerebral infarction.