Lansoprazole for the Prevention of Recurrences of Ulcer Complications from Long-Term Low-Dose Aspirin Use

• Published in: The New England journal of medicine Vol. 346; no. 26; pp. 2033 - 2038
• Main Authors: Lai, Kam Chuen, Lai, Ching Lung, Lam, Shiu Kum, Chu, Kent Man, Wong, Benjamin C.Y, Wong, John, Wong, Wai Man, Hui, Wai Mo, Hu, Wayne H.C, Lau, George K.K, Yuen, Man Fung, Chan, Annie O.O
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 27-06-2002
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles; Aged; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Ulcer Agents - therapeutic use; Aspirin; Aspirin - adverse effects; Biological and medical sciences; Colleges & universities; Digestive system; Drug dosages; Enzyme Inhibitors - therapeutic use; Female; Helicobacter Infections - drug therapy; Helicobacter pylori; Humans; Infections; Lansoprazole; Male; Medical sciences; Middle Aged; Omeprazole - analogs & derivatives; Omeprazole - therapeutic use; Peptic Ulcer - chemically induced; Peptic Ulcer - microbiology; Peptic Ulcer - prevention & control; Peptic Ulcer Hemorrhage - chemically induced; Peptic Ulcer Hemorrhage - microbiology; Peptic Ulcer Hemorrhage - prevention & control; Pharmacology. Drug treatments; Platelet Aggregation Inhibitors - adverse effects; Proportional Hazards Models; Prospective Studies; Proton Pump Inhibitors; Recurrence; Statistics, Nonparametric; Ulcers; Human; Stomach; Relapse; Enzyme; Low dose; H; Enzyme inhibitor; Acetylsalicylic acid; K; Long term; Proton pump inhibitor; Prevention; Chemotherapy; Benzimidazole derivatives; Antisecretory agent; Digestive diseases; Hydrolases; Complication; exchanging ATPase; Ulcer; Salicylates; Lansoprazole; Gastric disease
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa012877

The use of low-dose aspirin as prophylaxis against cardiac events or stroke and the presence of
Helicobacter pylori
infection are both risk factors for upper gastrointestinal tract bleeding from ulcers. In this study, patients taking low-dose aspirin who had both bleeding from ulcers and
H. pylori
infection had the latter eradicated and were then randomly assigned to receive lansoprazole (62 patients) or placebo (61 patients) and were followed for a median of 12 months while the low-dose aspirin treatment was continued. There was one recurrence of ulcer complications in the lansoprazole group and nine in the placebo group (P=0.008).
After the eradication of
H. pylori
infection, low-dose aspirin therapy can be continued more safely if lansoprazole is added to the therapeutic regimen.
The efficacy of low-dose aspirin (less than 325 mg daily) in the prevention of cardiovascular and cerebrovascular diseases is well established.
1
Patients who are taking low-dose aspirin, however, have an increased risk of ulcer complications,
2
and some of these patients should be given prophylactic treatment.
One of the available options for preventing these ulcer complications is the simultaneous use of proton-pump inhibitors, which reduce gastric acidity substantially. In a recent epidemiologic study, the use of a proton-pump inhibitor was found to be associated with a decrease of 80 percent in the risk of gastrointestinal bleeding in subjects taking low-dose aspirin. . . .