Aspirin Cardiovascular/Gastrointestinal Risk Calculator

Aspirin has been shown to be worthy of consideration for secondary, and in some cases primary, prevention of heart attacks and strokes but carries known risks for gastrointestinal side effects. If you're not certain whether to recommend low-dose aspirin to a patient, the aspirin cardiovascular/gastrointestinal risk calculator can help with the clinical decision. A paper recently published in the journal Alimentary Pharmacology and Therapeutics describes the development and use of this practical tool. The investigators state:

"Assessment of both GI and CV risks vs. the benefits of low-dose aspirin for individual patients can be difficult in clinical practice."

Therefore they determined to...

"...develop a tool to estimate CV and GI risks to facilitate the clinical decision-making process...We constructed risk-ratio estimations and determined the incidence of CV events and upper GI complications according to the presence of different risk factors. For upper GI complications we assumed a baseline incidence of 1 case/1000-persons-year, a twofold increased risk with low-dose aspirin, and estimated a 60% GI risk reduction with proton pump inhibitors (PPI) co-therapy and a 60% risk reduction with H. pylori eradication in patients with a history of peptic ulcer."

The full text of their paper is available at Medscape Family Medicine. A summary of their results states:

"In patients with low CV risk the number of GI complications induced by low-dose aspirin may be greater than the number of CV events prevented. In patients with high CV risk, low-dose aspirin is recommended, but the number of GI complications induced may still overcome the CV events saved. The use of PPI reduces the number of complication events induced by low-dose aspirin, but the number of CV events saved may still be offset by the number of GI complications induced in patients at very high GI risk."

The authors conclude:

"...the use of algorithms to integrate the stratification of individual CV risk with that of upper GI risk is an important clinical situation to consider in patients with suspected coronary artery disease. A proper quantification of GI risk should identify patients who may benefit more from the avoidance of LDA therapy, or from the addition of appropriate therapeutic modifications to avoid complications and obtain the maximal benefit of LDA. For this reason, the use of the aspirin CV/GI risk calculator should guide physicians in choosing appropriate treatment for primary CV prevention."