Quality standard
Quality statement 10: Continuation on low-dose aspirin
Quality statement 10: Continuation on low-dose aspirin
Quality statement
People with acute upper gastrointestinal bleeding who take aspirin for secondary prevention of vascular events and in whom haemostasis has been achieved are advised to continue on low-dose aspirin.
Rationale
Aspirin can cause gastrointestinal ulcers to form and cause pre-existing ulcers to bleed. Clinicians have therefore withheld aspirin at the time of acute gastrointestinal bleeding. However, the antiplatelet effects of aspirin persist for at least 7 days after discontinuation. This means that people with acute upper gastrointestinal bleeding who are already taking low-dose aspirin to prevent further vascular events should be advised to continue taking aspirin if their bleeding has stabilised so that the benefit of taking aspirin can be maintained.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that people with acute upper gastrointestinal bleeding who take aspirin for secondary prevention of vascular events and in whom haemostasis has been achieved are advised to continue on low-dose aspirin.
Data source: Local data collection.
Process
Proportion of people with acute upper gastrointestinal bleeding who take aspirin for secondary prevention of vascular events and in whom haemostasis has been achieved who are advised to continue on low-dose aspirin.
Numerator – the number of people in the denominator who are advised to continue on low-dose aspirin.
Denominator – the number of people with acute upper gastrointestinal bleeding who take aspirin for secondary prevention of vascular events and in whom haemostasis has been achieved.
Data source: Local data collection. The British Society of Gastroenterology's UK comparative audit of upper gastrointestinal bleeding and the use of blood (2007) records the drugs taken by people who have acute upper gastrointestinal bleeding.
What the quality statement means for different audiences
Service providers ensure that systems are in place to advise people with acute upper gastrointestinal bleeding who take aspirin for secondary prevention of vascular events and in whom haemostasis has been achieved to continue on low-dose aspirin.
Healthcare practitioners advise people with acute upper gastrointestinal bleeding, who take aspirin for secondary prevention of vascular events and in whom haemostasis has been achieved, to continue on low-dose aspirin.
Commissioners ensure that they commission services that advise people with acute upper gastrointestinal bleeding who take aspirin for secondary prevention of vascular events and in whom haemostasis has been achieved to continue on low-dose aspirin.
People with acute upper gastrointestinal bleeding who have had a stroke or heart attack, and are taking aspirin to prevent another, are advised to continue on aspirin when their bleeding has stabilised.
Source guidance
Acute upper gastrointestinal bleeding in over 16s: management. NICE guideline CG141 (2012, updated 2016), recommendation 1.6.1