Which medications are known to increase the risk of upper gastrointestinal (GI) bleeding?

Aspirin is well-documented for its role in increasing the risk of upper gastrointestinal (GI) bleeding due to its mechanism of action as a nonsteroidal anti-inflammatory drug (NSAID). Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes, leading to decreased production of thromboxane A2, which is crucial for platelet aggregation. This anticoagulant effect can precipitate bleeding, especially in the upper GI tract, where mucosal irritation and ulceration can also occur as a result of its irritative properties.

In contrast, acetaminophen and paracetamol (which is essentially the same compound, just known by different names in different regions) are not associated with an increased risk of GI bleeding. They work differently by inhibiting prostaglandin synthesis primarily in the central nervous system rather than in peripheral tissues, and they do not cause mucosal irritation. Instead, amoxicillin is an antibiotic that does not have a direct correlation with GI bleeding; it primarily functions to eliminate bacterial infections and is not known for increasing mucosal vulnerability.

Aspirin’s established role in gastric mucosal irritation, coupled with its platelet-inhibiting properties, clearly distinguishes it as a medication that raises the risk of upper GI