Cited by 405Antiplatelet Therapy and Cardiovascular DiseasesGastrointestinal Bleeding Diagnosis and TreatmentHelicobacter pylori-related gastroenterology studies

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Use of single and combined antithrombotic therapy and risk of serious upper gastrointestinal bleeding: population based case-control study

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Hallas, Jesper, Dall, Michael, Andries, Alin, Andersen, Birthe Søgaard, Aalykke, Claus, Hansen, Jane Møller, Andersen, Morten, Lassen, Annmarie Touborg·2006·BMJ

DOI 10.1136/bmj.38947.697558.ae

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Abstract

OBJECTIVES: To assess the risk of serious upper gastrointestinal bleeding associated with the newer antithrombotic agents used alone or in combination with other antithrombotic drugs; to describe the trends in use of antithrombotic drugs in the background population. DESIGN: Population based case-control study. SETTING: Funen County, Denmark (population 470,000). SUBJECTS: 1443 cases of serious upper gastrointestinal bleeding identified during 2000-4; 57,720 age and sex matched controls. MAIN OUTCOME MEASURE: Exposure to low dose aspirin, clopidogrel, dipyridamole, vitamin K antagonists, and combined antithrombotic treatment. RESULTS: Adjusted odds ratios associating drug use with upper gastrointestinal bleeding were 1.8 (95% confidence interval 1.5 to 2.1) for low dose aspirin, 1.1 (0.6 to 2.1) for clopidogrel, 1.9 (1.3 to 2.8) for dipyridamole, and 1.8 (1.3 to 2.4) for vitamin K antagonists. Corresponding figures for combined use were 7.4 (3.5 to 15) for clopidogrel and aspirin, 5.3 (2.9 to 9.5) for vitamin K antagonists and aspirin, and 2.3 (1.7 to 3.3) for dipyridamole and aspirin. Other combinations were used too infrequently to allow estimation. The number of treatment years needed to produce one excess case varied from 124 for the clopidogrel-aspirin combination to 8800 for clopidogrel alone. During the study period, exposure to combined antithrombotic regimens increased by 425% in the background population. CONCLUSION: Antithrombotic treatment is becoming increasingly aggressive. Combined antithrombotic treatment confers particular risk and is associated with high incidence of gastrointestinal bleeding.

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Authors: Hallas, J., Dall, M., Andries, A., Andersen, B. S., Aalykke, C., Hansen, J. M., Andersen, M., & Lassen, A. T.
Affiliations: University of Southern Denmark (DK)
Odense University Hospital (DK)
Corresponding author: Hallas, Jesper
ORCID: Hallas, Jesper
Aalykke, Claus
Andersen, Morten
Lassen, Annmarie Touborg
Venue: BMJ
Publisher: BMJ
Published: 2006-09-19
Volume: 333
Issue: 7571
Pages: 726
ISSN: 0007-1447 (ISSN-L)
0959-8138
1468-5833
DOI: 10.1136/bmj.38947.697558.ae
OpenAlex: W2120642548
Cited by: 403
References: 35
Citations by year: 2026: 6 · 2025: 4 · 2024: 12 · 2023: 17 · 2022: 9 · 2021: 11 · 2020: 16 · 2019: 14 · 2018: 10 · 2017: 23 · 2016: 25 · 2015: 25 · 2014: 33 · 2013: 26 · 2012: 25
FWCI: 17.99
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.bmj.org/licenses/tdm/1.0/terms-and-conditions.html (tdm)
Locations: BMJ (publishedVersion)
PubMed (publishedVersion)
University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
HighWire Press Open Archive (submittedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
Health Sciences › Medicine › Gastroenterology › Helicobacter pylori-related gastroenterology studies
Keywords: upper gastrointestinal bleeding, antithrombotic therapy, clopidogrel, aspirin, dipyridamole, vitamin K antagonists, combination antithrombotic therapy, bleeding risk
MeSH terms: Aged, Aspirin, Drug Therapy, Combination, Female, Fibrinolytic Agents, Gastrointestinal Hemorrhage, Humans, Male, Peptic Ulcer Hemorrhage, Platelet Aggregation Inhibitors, Stomach Ulcer, Case-Control Studies

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Use of single and combined antithrombotic therapy and risk of serious upper gastrointestinal bleeding: population based case-control study

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