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.
In a study from the University of Nottingham, scientists found that the risk of stomach bleeding caused by using aspirin long-term can be reduced with a short course of antibiotics.
The findings may help improve the safety of aspirin when used to prevent heart attacks, strokes and possibly some cancers.
By thinning the blood, aspirin makes ulcers in the stomach bleed. These ulcers may be caused by a particular type of bacteria, helicobacter pylori.
In the study, the team examined whether a short course of antibiotics to remove these bacteria would reduce the risk of bleeding in aspirin users.
The study was conducted in 1,208 UK general practices. It was a real-life study that used clinical data routinely stored in general practitioner 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 assigned 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 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.
The team says they are pleased that the findings have shown that ulcer bleeding can be significantly reduced following a one-week course of antibiotics.
The long-term implications of the results are encouraging in terms of safe prescribing.
If you care about aspirin, please read studies that aspirin could cut cancer death by 20%, and Aspirin, common anti-inflammatory drugs may prevent COVID-19 deaths.
For more information about aspirin, please see recent studies that people over 60 should not take daily aspirin for heart health, and results showing daily aspirin may not benefit healthy older people.
The study was conducted by Professor Chris Hawkey et al and published in The Lancet.
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