I dont think 81 mg is going to hurt anyone, but the ECA stack might if used to much!
1. Excess Mortality from Gastrointestinal Bleeding Associated with NSAIDs in the United States
Epidemiologic evidence suggests that 99% of the excess mortality from NSAID use was attributable to gastrointestinal complications [Report of CIOMS Working Group IV 1998]. Annually, 1% to 2% of people taking NSAIDs on a regular basis experience serious gastrointestinal complications that result in hospitalization [Singh 2000]. Estimates of the number of deaths from NSAID-related gastrointestinal bleeding vary widely.
Singh [2000] estimated that 103,000 individuals are hospitalized annually in the United States for NSAID-related serious gastrointestinal complications at a cost in excess of two billion dollars. In addition, Singh [2000] estimated that 16,500 NSAID-related deaths occur each year in the United States among patients with rheumatoid arthritis and osteoarthritis. Presumably, these estimates are based primarily on prescription NSAIDs used for longer time periods than the OTC label recommends, but as noted earlier, some individuals may use OTC NSAIDs in excess of the OTC recommended dose or take two or more OTC NSAIDs concurrently.
A more conservative estimate came from Blot and McLaughlin [personal communication McLaughlin 2001] who estimated that 9400 Americans, age 25 years or older, die from upper gastrointestinal bleeding per year. This is based on United States mortality data from the National Center for Health Statistics from 1990 through 1999.
Using the pooled relative risk of upper gastrointestinal bleeding from cohort studies determined by Ofman [Ofman 2002] of 2.7 (95% CI: 2.1, 3.5), McNeil estimated that the number of excess deaths per year from gastrointestinal bleeding secondary to NSAID use among adults in the United States is 3443 (95% CI; 2559, 4319). The point estimate of the number of excess deaths was calculated as follows. Estimates for the upper and lower 95% confidence interval were calculated in the same manner.
• Deaths per year attributable to NSAIDs in the United States
= deaths per year from gastrointestinal bleeding (9400)
1. Aspirin
Adverse gastrointestinal effects are a well known risk associated with the use of aspirin, including low-dose aspirin [Kurata 1990; Laporte 1991; Levy 1988] and appear to be dose-related [Prichard 1987; Weil 1995]. The United Kingdom-transient ischemic attack (TIA) aspirin trial [UK-TIA Study Group 1991], a randomized, double-blind, placebo-controlled trial, compared aspirin doses of 300 mg/day (once daily) and 1200 mg/day (600 mg twice daily) with placebo in 2435 patients (following a recent TIA or minor ischemic stroke) with a mean follow-up of about four years. There was a dose-related increase in gastrointestinal hemorrhage with 3% and 5% of the patients assigned to 300 mg of aspirin and 1200 mg of aspirin, respectively, reporting gastrointestinal hemorrhage compared with 1% of placebo patients.
Weil et al [1995] evaluated the risk for peptic ulcer with prophylactic aspirin therapy at doses of 75 mg, 150 mg, and 300 mg daily and reported odds ratios (OR) that increased with daily dose: 2.3 (95% CI: 1.2, 4.4) for 75 mg, 3.2 (95% CI: 1.7, 6.5) for 150 mg, and 3.9 (95% CI: 2.5, 6.3) for 300 mg. Prichard and colleagues [1987] observed a significant increase in gastric mucosal bleeding from baseline with a daily aspirin dose of 75 mg, which increased two-fold at a dose of 300 mg daily (when compared with 75 mg) and increased more than five-fold at a dose of 1.8 grams/day (when compared with 75 mg).
Derry and Loke [Derry 2000] conducted a meta-analysis of 24 randomized controlled trials that evaluated almost 66,000 patients. They specifically evaluated the effect of aspirin dose and formulation on the occurrence of gastrointestinal hemorrhage. Gastrointestinal hemorrhage occurred in 2.47% of patients taking aspirin compared with 1.42% of patients taking placebo (OR 1.68; 95% CI: 1.51, 1.88; p<0.0001). In a separate analysis of eight trials using aspirin at doses of 50 to 162.5 mg per day, gastrointestinal hemorrhage occurred in 2.30% of patients taking aspirin compared with 1.45% of patients taking placebo (OR 1.59; 95% CI: 1.40, 1.81; p<0.0001).
In a case-control study involving 550 incident cases of upper gastrointestinal bleeding and 1202 population controls [Kelly 1996], a statistically significant increased risk (estimated RR ranging from 2.6 to 3.1, depending on aspirin formulation, ie, plain, enteric-coated, or buffered) of upper gastrointestinal bleeding was reported for patients regularly taking<325 mg/day of aspirin. An even greater increased risk (5.8- to 7.0-fold) of upper gastrointestinal bleeding was associated with regular intake of aspirin at doses above 325 mg/day.
**broken link removed**