Introduction: The antiplatelet effects of low-dose aspirin (LDA) vary between individuals. Here, we investigated the relationship between the incidence of LDA-induced mucosal injury, antiplatelet effects of LDA, and intragastric pH. Methods: We evaluated gastric injury severity and platelet function using the VerifyNow® System before and after administration of 100 mg aspirin for 7 days to 18 young healthy subjects (study 1). We investigated whether injury was correlated with platelet function and gastric juice pH in 45 patients with cardiovascular disease administered LDA daily (study 2). Results: In study 1, platelet aggregation was attenuated by LDA to different degrees. Although 55.6% of subjects (10/18) developed gastric injury of modified Lanza score (MLS) ≥3, no significant difference in platelet function was detected between the mild (n = 8, MLS: 0-2) and severe injury groups (n = 10, MLS: 3-5). In study 2, the severity of LDA-induced injury was associated with gastric juice pH, but not with antiplatelet effects of LDA. Discussion: In contrast to gastric juice pH, the antiplatelet effect had no correlation with the severity of gastric mucosal injury. Monitoring gastric acidity, rather than platelet function, may be useful for predicting the risk of gastric injury during LDA treatment.

1.
Awtry EH, Loscalzo J: Aspirin. Circulation 2000;101:1206-1218.
[PubMed]
2.
Derry S, Loke YK: Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis. BMJ 2000;321:1183-1187.
[PubMed]
3.
Taha AS, Angerson WJ, Knill-Jones RP, Blatchford O: Upper gastrointestinal haemorrhage associated with low-dose aspirin and anti-thrombotic drugs - a 6-year analysis and comparison with non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 2005;22:285-289.
[PubMed]
4.
Nishino M, Sugimoto M, Kodaira C, Yamade M, Uotani T, Shirai N, Ikuma M, Tanaka T, Sugimura H, Hishida A, Furuta T: Preventive effects of lansoprazole and famotidine on gastric mucosal injury induced by low-dose aspirin in Helicobacter pylori-negative healthy volunteers. J Clin Pharmacol 2011;51:1079-1086.
[PubMed]
5.
Sugimoto M, Nishino M, Kodaira C, Yamade M, Ikuma M, Tanaka T, Sugimura H, Hishida A, Furuta T: Esophageal mucosal injury with low-dose aspirin and its prevention by rabeprazole. J Clin Pharmacol 2010;50:320-330.
[PubMed]
6.
Sugimoto M, Nishino M, Kodaira C, Yamade M, Uotani T, Ikuma M, Furuta T: Impact of acid inhibition on esophageal mucosal injury induced by low-dose aspirin. Digestion 2011;85:9-17.
[PubMed]
7.
Uotani T, Sugimoto M, Nishino M, Kodaira C, Yamade M, Sahara S, Yamada T, Osawa S, Sugimoto K, Tanaka T, Umemura K, Watanabe H, Miyajima H, Furuta T: Ability of rabeprazole to prevent gastric mucosal damage from clopidogrel and low doses of aspirin depends on CYP2C19 genotype. Clin Gastroenterol Hepatol 2012;10:879-885.e2.
[PubMed]
8.
Yeomans ND, Lanas AI, Talley NJ, Thomson AB, Daneshjoo R, Eriksson B, Appelman-Eszczuk S, Langstrom G, Naesdal J, Serrano P, Singh M, Skelly MM, Hawkey CJ: Prevalence and incidence of gastroduodenal ulcers during treatment with vascular protective doses of aspirin. Aliment Pharmacol Ther 2005;22:795-801.
[PubMed]
9.
Wolfe MM, Lichtenstein DR, Singh G: Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med 1999;340:1888-1899.
[PubMed]
10.
Sciulli MG, Renda G, Capone ML, Tacconelli S, Ricciotti E, Manarini S, Evangelista V, Rebuzzi A, Patrignani P: Heterogeneity in the suppression of platelet cyclooxygenase-1 activity by aspirin in coronary heart disease. Clin Pharmacol Ther 2006;80:115-125.
[PubMed]
11.
Patrono C, Garcia Rodriguez LA, Landolfi R, Baigent C: Low-dose aspirin for the prevention of atherothrombosis. N Engl J Med 2005;353:2373-2383.
[PubMed]
12.
Sanderson S, Emery J, Baglin T, Kinmonth AL: Narrative review: aspirin resistance and its clinical implications. Ann Intern Med 2005;142:370-380.
[PubMed]
13.
Shantsila E, Watson T, Lip GY: Aspirin resistance: what, why and when? Thromb Res 2007;119:551-554.
[PubMed]
14.
Poulsen TS, Jorgensen B, Korsholm L, Bjorn Licht P, Haghfelt T, Mickley H: Prevalence of aspirin resistance in patients with an evolving acute myocardial infarction. Thromb Res 2007;119:555-562.
[PubMed]
15.
Lanza FL, Royer GL Jr, Nelson RS, Chen TT, Seckman CE, Rack MF: A comparative endoscopic evaluation of the damaging effects of nonsteroidal anti-inflammatory agents on the gastric and duodenal mucosa. Am J Gastroenterol 1981;75:17-21.
[PubMed]
16.
Naito Y, Yoshikawa T, Iinuma S, Yagi N, Matsuyama K, Boku Y, Fujii T, Yoshida N, Kondo M, Sasaki E: Rebamipide protects against indomethacin-induced gastric mucosal injury in healthy volunteers in a double-blind, placebo-controlled study. Dig Dis Sci 1998;43:83S-89S.
[PubMed]
17.
Breet NJ, van Werkum JW, Bouman HJ, Kelder JC, Ruven HJ, Bal ET, Deneer VH, Harmsze AM, van der Heyden JA, Rensing BJ, Suttorp MJ, Hackeng CM, ten Berg JM: Comparison of platelet function tests in predicting clinical outcome in patients undergoing coronary stent implantation. JAMA 2010;303:754-762.
[PubMed]
18.
Lanas AI, Arroyo MT, Esteva F, Cornudella R, Hirschowitz BI, Sainz R: Aspirin related gastrointestinal bleeders have an exaggerated bleeding time response due to aspirin use. Gut 1996;39:654-660.
[PubMed]
19.
Kitahora T, Guth PH: Effect of aspirin plus hydrochloric acid on the gastric mucosal microcirculation. Gastroenterology 1987;93:810-817.
[PubMed]
20.
Nishino M, Sugimoto M, Kodaira C, Yamade M, Shirai N, Ikuma M, Tanaka T, Sugimura H, Hishida A, Furuta T: Relationship between low-dose aspirin-induced gastric mucosal injury and intragastric pH in healthy volunteers. Dig Dis Sci 2010;55:1627-1636.
[PubMed]
21.
Pilotto A, Franceschi M, Leandro G, Paris F, Cascavilla L, Longo MG, Niro V, Andriulli A, Scarcelli C, Di Mario F: Proton-pump inhibitors reduce the risk of uncomplicated peptic ulcer in elderly either acute or chronic users of aspirin/non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 2004;20:1091-1097.
[PubMed]
22.
Serrano P, Lanas A, Arroyo MT, Ferreira IJ: Risk of upper gastrointestinal bleeding in patients taking low-dose aspirin for the prevention of cardiovascular diseases. Aliment Pharmacol Ther 2002;16:1945-1953.
[PubMed]
23.
Ruiz B, Correa P, Fontham ET, Ramakrishnan T: Antral atrophy, Helicobacter pylori colonization, and gastric pH. Am J Clin Pathol 1996;105:96-101.
[PubMed]
24.
Furuta T, Baba S, Takashima M, Futami H, Arai H, Kajimura M, Hanai H, Kaneko E: Effect of Helicobacter pylori infection on gastric juice pH. Scand J Gastroenterol 1998;33:357-363.
[PubMed]
25.
Furuta T, Shirai N, Takashima M, Xiao F, Sugimura H: Effect of genotypic differences in interleukin-1 beta on gastric acid secretion in Japanese patients infected with Helicobacter pylori. Am J Med 2002;112:141-143.
[PubMed]
26.
Cryer B, Feldman M: Effects of very low dose daily, long-term aspirin therapy on gastric, duodenal, and rectal prostaglandin levels and on mucosal injury in healthy humans. Gastroenterology 1999;117:17-25.
[PubMed]
27.
Lanza FL, Royer GL Jr, Nelson RS, Chen TT, Seckman CE, Rack MF: A comparative endoscopic evaluation of the damaging effects of nonsteroidal anti-inflammatory agents on the gastric and duodenal mucosa. Am J Gastroenterol 1981;75:17-21.
[PubMed]
28.
Naito Y, Yoshikawa T, Iinuma S, Yagi N, Matsuyama K, Boku Y, Fujii T, Yoshida N, Kondo M, Sasaki E: Rebamipide protects against indomethacin-induced gastric mucosal injury in healthy volunteers in a double-blind, placebo-controlled study. Dig Dis Sci 1998;43:83S-89S.
[PubMed]
You do not currently have access to this content.