It seems like everybody admitted to the hospital is either on aspirin or should be taking aspirin. How soon do you restart aspirin if the patient comes with GI bleeding?

The study published in Annals of Internal Medicine addresses the issue of continuing aspirin therapy in patients admitted with peptic ulcer bleeding. All patients receive proton pump inhibitor therapy as well as an endoscopic treatment for bleeding. The patients in the aspirin group have a higher risk of rebleeding within 30 days (10.3% in aspirin group vs. 5.4% in placebo group). There is no surprise here – aspirin will increase the risk of bleeding.

The interesting finding in this study was that the patients in the aspirin treatment group had significantly lower all-cause mortality within 8 weeks (1.3% in aspirin group vs. 12.9% in placebo group). This is a very significant difference.

Obviously, the study has limitations. Small sample size (156 patients total) and single center design might skew the results of this study. Also, it would be interesting to see how treatment with aspirin effects rebleeding risk and mortality in other causes of gastrointestinal bleeding.