A recent study led by researchers at the University of Nottingham discovered that a brief course of antibiotics can lower the risk of stomach bleeding brought on by long-term aspirin use, potentially increasing the safety of aspirin when used to prevent heart attacks, strokes, and possibly some cancers.
The Lancet has published the findings of the Helicobacter pylori Eradication with Aspirin (HEAT) trial, which was directed by Professor Chris Hawkey of the University of Nottingham’s School of Medicine and Nottingham Digestive Diseases Centre and supported by the National Institute for Health and Care Research’s Health Technology Assessment program.
Low dosages of aspirin are a very helpful prophylactic medication for those who are at high risk for heart attacks or strokes. It can, however, occasionally cause internal ulcer bleeding.
Aspirin causes stomach ulcers to bleed because it thins the blood. Helicobacter pylori is a specific form of bacteria that may be to blame for these ulcers.
The University of Nottingham’s STAR (Simple Trials for Academic Research) team looked into whether a brief course of antibiotics to get rid of these bacteria would lower the risk of bleeding in aspirin users.
A very sizable trial called the HEAT (Helicobacter pylori Eradication Aspirin) Trial was carried out in 1,208 UK general practices. It was a real-world study that did not require the patients to return for additional trial visits, instead using clinical data that is normally kept in GP and hospital records.
The team wrote to 188,875 aspirin-taking individuals, and 30,166 of them agreed to participate in the trial. H. pylori-positive individuals were randomly assigned to either antibiotics or placebos (dummy pills), and they were monitored for up to 7 years after receiving treatment.
Over the first two and a half years, individuals who received antibiotic treatment had a lower hospital admission rate for ulcer bleeding than those who received placebo pills (6 versus 17). Protection happened quickly: compared to 525 days after receiving antibiotic treatment, the first hospitalization for ulcer bleeding was after 6 days in individuals who got placebos (dummy treatment).
Protection seems to diminish over a longer period of time. The overall rate of ulcer bleeding hospitalizations was lower than anticipated, though, and this is consistent with recent data indicating ulcer disease is declining. Low risks apply to those using aspirin already. When taking aspirin for the first time, when it may be advantageous to look for and cure H. pylori, the risks are increased.
Chris Hawkey, an academic, said: “In terms of lowering the risk of heart attacks and strokes in those who are at higher risk, aspirin offers several advantages.” Additionally, there is proof that it can slow down some malignancies. We are happy that the results of the largest UK-based study of its kind, the HEAT trial, have demonstrated that ulcer bleeding can be greatly decreased after taking antibiotics for one week. “The results’ long-term implications for safe prescribing are positive.”
The trial’s findings will be shared at the UEG (United European Gastroenterology) scientific meeting in Vienna, where they earned the top abstract prize of 10,000 euros. The prize money will be used by the STAR team to finance a contest in support of a partnership with a research team that wants to employ the STAR approach.
