For people who have successfully undergone Helicobacter pylori-eradication therapy, the use of aspirin does more good than harm, such that the benefit of reduced gastrointestinal (GI) cancer-related mortality outweighs the risk of bleeding-related mortality, according to a study.
Researchers used a territory-wide database and identified 87,967 H pylori-eradicated patients. The primary outcome of GI cancer-related (gastrointestinal, hepatobiliary or pancreatic cancer) death was examined in relation to aspirin exposure. Bleeding-related (GIB or intracranial bleeding) death was also evaluated as a secondary outcome.
Multivariable Cox model was applied in the analyses, with adjustments for age, sex, comorbidities, and concomitant medications. Benefit-risk profile was expressed as adjusted absolute risk difference of cancer-related deaths and bleeding-related deaths between aspirin users and nonusers.
Over a median follow-up of 10.1 years, a total of 1,294 GI cancer-related deaths (1.5 percent) and 304 bleeding-related deaths (0.3 percent) occurred. Compared with nonusers, aspirin users had a lower risk of GI cancer-related mortality (adjusted hazard ratio [aHR], 0.51, 95 percent confidence interval [CI], 0.42–0.61) but higher risk of bleeding-related mortality (aHR, 1.52, 95 percent CI, 1.11–2.08).
However, patients who used proton pump inhibitors (PPIs) were able to mitigate the risk of bleeding-related mortality associated with aspirin use (aHR, 1.06, 95 percent CI, 0.70–1.63).
In the entire cohort, the adjusted absolute risk difference indicated that aspirin users versus nonusers had 7 (95 percent CI, 5–8) fewer cancer-related deaths and 1 (95 percent CI, 0.3–3) more bleeding-related death per 10,000 person-years. Among concomitant PPI–aspirin users, there were 9 (95 percent CI, 8–10) fewer cancer-related deaths per 10,000 person-years without any increase in bleeding-related deaths.