{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:28:19Z","timestamp":1786739299160,"version":"build-2736575974"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec>\n                    <jats:title>Aims:<\/jats:title>\n                    <jats:p>To determine the long-term incidence and outcome of gastrointestinal (GI) bleeding in users of aspirin with (dual antiplatelet therapy, DAPT) or without clopidogrel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Settings and Design:<\/jats:title>\n                    <jats:p>Prospective hospital based 12-year study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Material:<\/jats:title>\n                    <jats:p>There were 1047 patients on either aspirin 150 md\/day alone (n = 574, 54.8%) or aspirin 75 md\/day + clopidogrel 75 md\/day (n = 473, 45.2%) were followed up for any incident GI bleed, rebleed and mortality. Those simultaneously using other drugs known to cause GI bleeding were excluded. Comorbidities, concomitant use of proton pump inhibitors and statins were noted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>GI bleed occurred in 11.8% after 8,683 person years of follow up. 56 (45%) patients had lower GI source of bleed [colon 9 (7%), small gut 47 (38%)] and 68 (55%) had upper GI source [duodenum 39 (32.3%), stomach 28 (22.6%) and oesophagus 1 (0.1%)]. Whereas stomach and duodenum were the chief sites in the first year, small gut predominated in later years. The cumulative bleeding rate after 1, 5 and 10 years was 5%, 8% and 11%, respectively, higher in the DAPT group. Bleeding stopped spontaneously in 98% on drug withdrawal, and 7.3% patients rebled in the next 6.2 years. The overall mortality was 33.1% but only 1.6% was due to the bleed being significantly lower in the DAPT group. On multivariate analysis coronary interventions, diabetes mellitus, renal and multiorgan dysfunction were the significant predictors of GI bleed and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Though the incidence and mortality are low, GI bleed increases with longer use of antiplatelet agents predominantly from the lower GI tract.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jfmpc.jfmpc_1298_22","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T03:51:56Z","timestamp":1675050716000},"page":"7750-7755","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Incidence and outcome of gastrointestinal bleeding in patients receiving aspirin with or without clopidogrel over 10 years- An observational study"],"prefix":"10.4103","volume":"11","author":[{"given":"Gautam","family":"Ray","sequence":"first","affiliation":[{"name":"Department of Medicine, B. R. Singh Hospital, Eastern Railway, Kolkata, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,1,17]]},"reference":[{"key":"R1-20260204","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1016\/S0140-6736(18)32203-7","article-title":"Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980\u20132017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"392","year":"2018","journal-title":"Lancet"},{"key":"R2-20260204","doi-asserted-by":"crossref","first-page":"40","DOI":"10.5492\/wjccm.v4.i1.40","article-title":"Treatment and prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy","volume":"4","author":"Yasuda","year":"2015","journal-title":"World J Crit Care Med"},{"key":"R3-20260204","first-page":"499","article-title":"Gastrointestinal bleeding in patients receiving antiplatelet and anticoagulant therapy: Practical guidance for restarting therapy and avoiding recurrences","volume":"55","author":"Pipilis","year":"2014","journal-title":"Hellenic J Cardiol"},{"key":"R4-20260204","doi-asserted-by":"crossref","first-page":"e15721","DOI":"10.1371\/journal.pone.0015721","article-title":"A prospective study of aspirin use and the risk of gastrointestinal bleeding in men","volume":"5","author":"Huang","year":"2010","journal-title":"PLoS One"},{"key":"R5-20260204","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.amjmed.2010.12.022","article-title":"Long-term use of aspirin and the risk of gastrointestinal bleeding","volume":"124","author":"Huang","year":"2011","journal-title":"Am J Med"},{"key":"R6-20260204","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1159\/000494543","article-title":"Predictors and management of antiplatelet-related bleeding complications for acute coronary syndrome in Chinese elderly patients","volume":"50","author":"Wana","year":"2018","journal-title":"Cell Physiol Biochem"},{"key":"R7-20260204","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.amjcard.2005.03.038","article-title":"Incidence and prognostic impact of gastrointestinal bleeding after percutaneous coronary intervention for acute myocardial infarction","volume":"96","author":"Abbas","year":"2005","journal-title":"Am J Cardiol"},{"key":"R8-20260204","doi-asserted-by":"crossref","first-page":"e003519","DOI":"10.1161\/CIRCINTERVENTIONS.115.003519","article-title":"Postdischarge bleeding after percutaneous coronary intervention and subsequent mortality and myocardial infarction insights from the HMO Research Network-Stent Registry","volume":"9","author":"Valle","year":"2016","journal-title":"Circ Cardiovasc Interv"},{"key":"R9-20260204","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.2169\/internalmedicine.48.2031","article-title":"Upper gastrointestinal bleeding in patients receiving dual antiplatelet therapy after coronary stenting","volume":"48","author":"Yasuda","year":"2009","journal-title":"Intern Med"},{"key":"R10-20260204","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1007\/s11606-012-2208-0","article-title":"Gastrointestinal events with clopidogrel: A nationwide population-based cohort study","volume":"28","author":"Grove","year":"2013","journal-title":"J Gen Intern Med"},{"key":"R11-20260204","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/archinte.165.7.784","article-title":"Bleeding complications associated with combinations of aspirin, thienopyridine derivatives, and warfarin in elderly patients following acute myocardial infarction","volume":"165","author":"Buresly","year":"2005","journal-title":"Arch Intern Med"},{"key":"R12-20260204","doi-asserted-by":"crossref","first-page":"e0160046","DOI":"10.1371\/journal.pone.0160046","article-title":"Bleeding risk with long-term low-dose aspirin: A systematic review of observational studies","volume":"11","author":"Garc\u00eda Rodr\u00edguez","year":"2016","journal-title":"PLoS One"},{"key":"R13-20260204","first-page":"1455","article-title":"Management of antithrombotic therapy after bleeding in patients with coronary artery disease and\/or atrial fibrillation: Expert consensus paper of the European Society of Cardiology Working Group on thrombosis","volume":"38","author":"Halvorsen","year":"2017","journal-title":"Eur Heart J"},{"key":"R14-20260204","doi-asserted-by":"crossref","first-page":"5382","DOI":"10.3748\/wjg.v21.i17.5382","article-title":"Proton pump inhibitors in prevention of low-dose aspirin-associated upper gastrointestinal injuries","volume":"21","author":"Mo","year":"2015","journal-title":"World J Gastroenterol"},{"key":"R15-20260204","doi-asserted-by":"crossref","first-page":"10477","DOI":"10.3748\/wjg.v22.i48.10477","article-title":"Protons pump inhibitor treatment and lower gastrointestinal bleeding: Balancing risks and benefits","volume":"22","author":"Lu\u00e9","year":"2016","journal-title":"World J Gastroenterol"},{"key":"R16-20260204","doi-asserted-by":"crossref","first-page":"976.e1","DOI":"10.1016\/j.ahj.2006.02.013","article-title":"Statins are associated with lower risk of gastrointestinal bleeding in patients with unstable coronary syndromes: Analysis of the orbofiban in patients with unstable coronary syndromes\u2013thrombolysis in myocardial infarction 16 (OPUS-TIMI 16) trial","volume":"151","author":"Atar","year":"2006","journal-title":"Am Heart J"},{"key":"R17-20260204","doi-asserted-by":"crossref","first-page":"2286","DOI":"10.1001\/jama.2012.5034","article-title":"Association of aspirin use with major bleeding in patients with and without diabetes","volume":"307","author":"De Berardis","year":"2012","journal-title":"JAMA"},{"key":"R18-20260204","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1093\/aje\/kwv255","article-title":"Statins and risk of bleeding: An analysis to evaluate possible bias due to prevalent users and healthy user aspects","volume":"183","author":"van Rein","year":"2016","journal-title":"Am J Epidemiol"}],"container-title":["Journal of Family Medicine and Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_1298_22","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T19:27:42Z","timestamp":1786735662000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_1298_22"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12]]},"references-count":18,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_1298_22","relation":{},"ISSN":["2249-4863","2278-7135"],"issn-type":[{"value":"2249-4863","type":"print"},{"value":"2278-7135","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12]]},"assertion":[{"value":"2022-06-24","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-12","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}