09 November 2022

A short course of antibiotics can reduce the risk of stomach bleeding caused by long-term use of aspirin, British researchers have reported.

The HEAT (Helicobacter Eradication Aspirin Trial) study, led by the University of Nottingham, concluded prescribing antibiotics could potentially improve the safety of aspirin when used to prevent heart attacks, strokes and cancers.

The trial was conducted in 1,208 UK general practices, using clinical data routinely stored in GP and hospital records.

The team recruited 30,166 patients aged 60 or older who were routinely taking aspirin. Of this group, more than 5,300 tested positive for Helicobacter pylori and were randomised to receive antibiotics or placebo. The cohort were followed for up to seven years through routinely collected primary and secondary care data.

The results, published last week in The Lancet, showed that over the first two and a half years, individuals who had antibiotic treatment were less likely to be admitted to hospital because of ulcer bleeding than those who had a placebo. There were six such admissions in the group receiving antibiotics, compared to 17 admissions in the group receiving placebo.

Antibiotic protection also occurred rapidly, with those who received placebo being hospitalised for ulcer bleeding after six days, compared to 525 days following antibiotic treatment.

Protection appeared to wane over time, but the overall rate of hospitalisation for ulcer bleeding was lower than expected.

Study leader Professor Chris Hawkey, from the University of Nottingham’s School of Medicine and Nottingham Digestive Diseases Centre, said risks for people already on aspirin are low. However, the risks are higher when people first start aspirin.

Prof Hawkey said: “Aspirin has many benefits in terms of reducing the risk of heart attacks and strokes in people at increased risk.

“There is also evidence that it is able to slow down certain cancers. The HEAT trial is the largest UK-based study of its kind, and we are pleased that the findings have shown that ulcer bleeding can be significantly reduced following a one-week course of antibiotics. The long-term implications of the results are encouraging in terms of safe prescribing.”


Hawkey C, Avery A, Coupland CAC, Crooks C, Dumbleton J, Hobbs FDR, Kendrick D, Moore M, Morris C, Rubin G, Smith M, Stevenson D, on behalf of the HEAT Trialists. (2022) “Helicobacter pylori eradication for primary prevention of peptic ulcer bleeding in older patients prescribed aspirin in primary care (HEAT): a randomised, double-blind, placebo-controlled trial.” The Lancet, doi: 10.1016/S0140-6736(22)01843-8

Link: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01843-8/fulltext

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