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Aspirin primary prevention after gastrointestinal bleed — SCE Geriatric Medicine MCQ

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HardPolypharmacyAspirin primary prevention after gastrointestinal bleedSCE Geriatric Medicine

An 82-year-old with haemostasis achieved after endoscopic treatment of a bleeding gastric ulcer takes naproxen, prednisolone, lansoprazole and aspirin started years ago solely for primary cardiovascular prevention. Which medication decision is most appropriate once its indication is verified?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Discontinue aspirin after confirming it serves primary prevention only

Explanation lettering: C = shown as A · A = shown as B · E = shown as C · B = shown as D · D = shown as E

A is correct: aspirin used solely for primary prevention should be stopped after a major ulcer bleed. B describes the early-resumption principle used for secondary prevention, not this indication. C substitutes another antiplatelet without an indication. D removes the ulcerogenic NSAID but also removes protective acid suppression while retaining aspirin. E restarts a medicine whose net preventive benefit no longer justifies its bleeding risk.

Reference: NICE CG141: acute upper gastrointestinal bleeding: https://www.nice.org.uk/guidance/cg141/chapter/Recommendations