A new study, led by experts at the University of Nottingham found that the risk of stomach bleeding caused by using aspirin long-term, can be reduced with a short course of antibiotics, potentially improving the safety of aspirin when used to prevent heart attacks, strokes and possibly some cancers.
Aspirin in low doses is a very useful preventative drug in people at high risk of strokes or heart attacks.
However, on rare occasions, it can provoke internal ulcer bleeding.
By thinning the blood, aspirin makes ulcers in the stomach bleed.
These ulcers may be caused by a particular type of bacteria, helicobacter pylori.
The team from the University of Nottingham investigated whether a short course of antibiotics to remove these bacteria would reduce the risk of bleeding in aspirin users.
The .HEAT (Helicobacter pylori Eradication Aspirin) Trial was a very large trial conducted in 1,208 UK general practices.
It was a real-life study which used clinical data routinely stored in GP and hospital records, instead of bringing patients back for follow up trial visits.
The team wrote to 188,875 patients who were taking aspirin and 30,166 volunteered and took part in the study.
Those who tested positive for H. pylori were randomized to receive antibiotics or placebos (dummy tablets) and were followed for up to 7 years.
Over the first two and a half years, those who had antibiotic treatment were less likely to be admitted to hospital because of ulcer bleeding than those who had dummy tablets (6 versus 17). Protection occurred rapidly: with those who received placebos (dummy treatment), the first hospitalization for ulcer bleeding occurred after 6 days, compared to 525 days following antibiotic treatment.
Over a longer time period, protection appeared to wane. However, the overall rate of hospitalization for ulcer bleeding was lower than expected and this is in line with other evidence that ulcer disease is on the decline.
Risks for people already on aspirin are low. Risks are higher when people first start aspirin, when searching for H. pylori and treating it is probably worthwhile.
Chris Hawkey, Anthony Avery, Carol A C Coupland, Colin Crooks, Jennifer Dumbleton, F D Richard Hobbs, Denise Kendrick, Michael Moore, Clive Morris, Gregory Rubin, Murray Smith, Diane Stevenson, David CA Mant, Alexander C Ford, Thomas M Macdonald, Mike Bradburn, Claire A Klauza, Angela Shone, Richard FA Logan, Jonathan J Deeks, Kenneth E.L. McColl, Andrew F Goddard, Richard Stevens, Sarned Sami, John Haughney, Margaret E Cupples, Monique Morar, Wendy O’Brien. Helicobacter pylori eradication for primary prevention of peptic ulcer bleeding in older patients prescribed aspirin in primary care (HEAT): a randomised, double-blind, placebo-controlled trial. The Lancet, 2022; 400 (10363): 1597 DOI: 10.1016/S0140-6736(22)01843-8
University of Nottingham. “Cutting the risk of stomach bleeding, occasionally caused by regular aspirin use.” ScienceDaily. ScienceDaily, 4 November 2022. <www.sciencedaily.com/releases/2022/11/221104093252.htm>.
Photo by Anna Shvets