ASP (PPI_H2RA) Study-H2RA Versus PPI for the Prevention of Recurrent UGIB in High-risk Users of Low-dose ASA
Status:
Completed
Trial end date:
2016-11-01
Target enrollment:
Participant gender:
Summary
Peptic ulcer bleeding associated with ASA or NSAIDs is a major cause of hospitalization in
Hong Kong. The investigators previously showed that ASA or NSAIDs accounted for about half of
all cases of hospitalizations for peptic ulcer bleeding. Currently, ASA use has contributed
to about one-third of the bleeding ulcers admitted to the investigators hospital that serves
a local population of 1.5 million.
In patients with acute coronary syndrome or acute ischemic stroke who develop ASA-induced
bleeding peptic ulcers, whether ASA should be discontinued before ulcers have healed is a
major dilemma. In another double-blind randomized trial, the investigators have shown that
discontinuation of ASA after endoscopic treatment of bleeding ulcers was associated with a
significantly increased in mortality within 8 weeks.
In the absence of safer aspirins, co-therapy with a gastroprotective drug remains the
dominant preventive strategy. Given the vast number of people taking ASA, however, it is only
cost-effective to identify and treat those who are at high risk of ulcer bleeding and who
have a strong indication for ASA use. Data from observational studies and randomized trials
have consistently shown that PPIs are effective in reducing the risk of ulcer bleeding
associated with ASA. Other potential preventive strategies include eradication of H. pylori
infection, substitution of ASA for other non-aspirin anti-platelet drugs, and co-therapy with
misoprostol or H2RAs.