A new study by the University of Nottingham found that the risk of stomach bleeding caused by long-term aspirin use can be reduced with a short course of antibiotics.
The University of Nottingham has found that the risk of stomach bleeding caused by aspirin use can be mitigated by a course of antibiotics, which could improve the safety of aspirin when used to prevent heart attacks, strokes and some cancers.
The results of the .HEAT (Helicobacter pylori Eradication Aspirin) trial which was led by Professor Chris Hawkey from the University of Nottingham’s School of Medicine and Nottingham Digestive Diseases Centre, and funded by the National Institute for Health and Care Research Health Technology Assessment Programme.
The results were published in The Lancet.
Aspirin is a useful preventive drug
Aspirin in low doses is a preventative drug and is used by people at high risk of strokes or heart attacks. However, it can cause internal ulcer bleeding. Aspirin works by thinning the blood, leading the ulcers to bleed. These ulcers can be caused by a particular type of bacteria, helicobacter pylori.
The STAR (Simple Trials for Academic Research) team from the University of Nottingham explored if a short course of antibiotics to remove these bacteria would reduce the risk of stomach bleeding in long-term aspirin users.
The .HEAT (Helicobacter pylori Eradication Aspirin) Trial was a large trial conducted in 1,208 UK general practices. It used real-life clinical data stored in GP and hospital records, instead of bringing patients back for follow-up trial visits.
Furthermore, 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 randomised to receive antibiotics or placebos and followed for up to seven years.
Stomach bleeding was reduced significantly following antibiotic use
In the first two and a half years, those who had antibiotic treatment were less likely to be admitted to the hospital because of stomach bleeding than those who had dummy tablets (six versus 17). Protection occurred quickly, with those who received placebos, the first hospitalisation for ulcer bleeding occurred after six days, compared to 525 days following antibiotic treatment.
The protection appeared to taper off over time. However, the overall rate of hospitalisation for stomach bleeding was lower than expected, and the evidence was in line with other studies. Risks for people already on aspirin are low, and the risk is higher for people who first start using the medication when searching for H.pylori, and treating it is probably worthwhile.
Professor Chris Hawkey said: “Aspirin has many benefits in terms of reducing the risk of heart attacks and strokes in people at increased risk. There is also evidence that it is able to slow down certain cancers. The .HEAT trial is the largest UK-based study of its kind, and we 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.”