# Low‐Dose Aspirin Induced Gastric Ulcer in a Patient With TIA: A Clinical Caution for Aspirin Therapy Without Gastroprotection

## TL;DR

A patient on low-dose aspirin for stroke prevention developed severe stomach ulcers, highlighting the need for gastroprotection to avoid serious side effects.

## Contribution

This case emphasizes the critical importance of using proton pump inhibitors alongside aspirin to prevent gastrointestinal bleeding.

## Key findings

- A 60-year-old man on low-dose aspirin developed life-threatening gastric ulcers without gastroprotection.
- Helicobacter pylori was not detected, indicating aspirin as the likely cause of the ulcers.
- The case underscores the necessity of systematic GI risk assessment and PPI co-prescription for at-risk patients.

## Abstract

Balancing the cerebrovascular benefits of low‐dose aspirin (LDA) with its significant gastrointestinal (GI) bleeding risk is a critical challenge in secondary stroke prevention. We describe a cautionary case of a 60‐year‐old male who, 6 months after starting LDA for a transient ischemic attack (TIA), presented with a life‐threatening upper GI bleed. The patient had not been prescribed a prophylactic proton pump inhibitor (PPI). Investigations revealed a hemoglobin of 9.6 g/dL and multiple gastric ulcers on endoscopy, with negative testing for
Helicobacter pylori
. This case of a preventable, severe adverse event serves as a stark reminder that guideline‐recommended gastroprotection is not optional but essential. Systematic risk assessment and PPI co‐prescription in at‐risk individuals are imperative for the safe and effective use of long‐term antiplatelet therapy.

Systematic gastrointestinal risk assessment is mandatory before initiating long‐term aspirin. For at‐risk patients, co‐prescribing a proton pump inhibitor is an essential safety measure that makes guideline‐based prophylaxis a core component of safe and effective secondary stroke prevention.