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Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations.
Gut. 2006 Dec; 55(12):1731-8.Gut

Abstract

BACKGROUND

The risks and benefits of coxibs, non-steroidal anti-inflammatory drugs (NSAIDs), and aspirin treatment are under intense debate.

OBJECTIVE

To determine the risk of peptic ulcer upper gastrointestinal bleeding (UGIB) associated with the use of coxibs, traditional NSAIDs, aspirin or combinations of these drugs in clinical practice.

METHODS

A hospital-based, case-control study in the general community of patients from the National Health System in Spain. The study included 2777 consecutive patients with endoscopy-proved major UGIB because of the peptic lesions and 5532 controls matched by age, hospital and month of admission. Adjusted relative risk (adj RR) of UGIB determined by conditional logistic regression analysis is provided.

RESULTS

Use of non-aspirin-NSAIDs increased the risk of UGIB (adj RR 5.3; 95% confidence interval (CI) 4.5 to 6.2). Among non-aspirin-NSAIDs, aceclofenac (adj RR 3.1; 95% CI 2.3 to 4.2) had the lowest RR, whereas ketorolac (adj RR 14.4; 95% CI 5.2 to 39.9) had the highest. Rofecoxib treatment increased the risk of UGIB (adj RR 2.1; 95% CI 1.1 to 4.0), whereas celecoxib, paracetamol or concomitant use of a proton pump inhibitor with an NSAID presented no increased risk. Non-aspirin antiplatelet treatment (clopidogrel/ticlopidine) had a similar risk of UGIB (adj RR 2.8; 95% CI 1.9 to 4.2) to cardioprotective aspirin at a dose of 100 mg/day (adj RR 2.7; 95% CI 2.0 to 3.6) or anticoagulants (adj RR 2.8; 95% CI 2.1 to 3.7). An apparent interaction was found between low-dose aspirin and use of non-aspirin-NSAIDs, coxibs or thienopyridines, which increased further the risk of UGIB in a similar way.

CONCLUSIONS

Coxib use presents a lower RR of UGIB than non-selective NSAIDs. However, when combined with low-dose aspirin, the differences between non-selective NSAIDs and coxibs tend to disappear. Treatment with either non-aspirin antiplatelet or cardioprotective aspirin has a similar risk of UGIB.

Authors+Show Affiliations

Servicio de Aparato Digestivo, Hospital Clínico Universitario, Zaragoza 50009, Spain. alanas@unizar.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16687434

Citation

Lanas, A, et al. "Risk of Upper Gastrointestinal Ulcer Bleeding Associated With Selective Cyclo-oxygenase-2 Inhibitors, Traditional Non-aspirin Non-steroidal Anti-inflammatory Drugs, Aspirin and Combinations." Gut, vol. 55, no. 12, 2006, pp. 1731-8.
Lanas A, García-Rodríguez LA, Arroyo MT, et al. Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations. Gut. 2006;55(12):1731-8.
Lanas, A., García-Rodríguez, L. A., Arroyo, M. T., Gomollón, F., Feu, F., González-Pérez, A., Zapata, E., Bástida, G., Rodrigo, L., Santolaria, S., Güell, M., de Argila, C. M., Quintero, E., Borda, F., & Piqué, J. M. (2006). Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations. Gut, 55(12), 1731-8.
Lanas A, et al. Risk of Upper Gastrointestinal Ulcer Bleeding Associated With Selective Cyclo-oxygenase-2 Inhibitors, Traditional Non-aspirin Non-steroidal Anti-inflammatory Drugs, Aspirin and Combinations. Gut. 2006;55(12):1731-8. PubMed PMID: 16687434.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations. AU - Lanas,A, AU - García-Rodríguez,L A, AU - Arroyo,M T, AU - Gomollón,F, AU - Feu,F, AU - González-Pérez,A, AU - Zapata,E, AU - Bástida,G, AU - Rodrigo,L, AU - Santolaria,S, AU - Güell,M, AU - de Argila,C M, AU - Quintero,E, AU - Borda,F, AU - Piqué,J M, AU - ,, Y1 - 2006/05/10/ PY - 2006/5/12/pubmed PY - 2007/1/4/medline PY - 2006/5/12/entrez SP - 1731 EP - 8 JF - Gut JO - Gut VL - 55 IS - 12 N2 - BACKGROUND: The risks and benefits of coxibs, non-steroidal anti-inflammatory drugs (NSAIDs), and aspirin treatment are under intense debate. OBJECTIVE: To determine the risk of peptic ulcer upper gastrointestinal bleeding (UGIB) associated with the use of coxibs, traditional NSAIDs, aspirin or combinations of these drugs in clinical practice. METHODS: A hospital-based, case-control study in the general community of patients from the National Health System in Spain. The study included 2777 consecutive patients with endoscopy-proved major UGIB because of the peptic lesions and 5532 controls matched by age, hospital and month of admission. Adjusted relative risk (adj RR) of UGIB determined by conditional logistic regression analysis is provided. RESULTS: Use of non-aspirin-NSAIDs increased the risk of UGIB (adj RR 5.3; 95% confidence interval (CI) 4.5 to 6.2). Among non-aspirin-NSAIDs, aceclofenac (adj RR 3.1; 95% CI 2.3 to 4.2) had the lowest RR, whereas ketorolac (adj RR 14.4; 95% CI 5.2 to 39.9) had the highest. Rofecoxib treatment increased the risk of UGIB (adj RR 2.1; 95% CI 1.1 to 4.0), whereas celecoxib, paracetamol or concomitant use of a proton pump inhibitor with an NSAID presented no increased risk. Non-aspirin antiplatelet treatment (clopidogrel/ticlopidine) had a similar risk of UGIB (adj RR 2.8; 95% CI 1.9 to 4.2) to cardioprotective aspirin at a dose of 100 mg/day (adj RR 2.7; 95% CI 2.0 to 3.6) or anticoagulants (adj RR 2.8; 95% CI 2.1 to 3.7). An apparent interaction was found between low-dose aspirin and use of non-aspirin-NSAIDs, coxibs or thienopyridines, which increased further the risk of UGIB in a similar way. CONCLUSIONS: Coxib use presents a lower RR of UGIB than non-selective NSAIDs. However, when combined with low-dose aspirin, the differences between non-selective NSAIDs and coxibs tend to disappear. Treatment with either non-aspirin antiplatelet or cardioprotective aspirin has a similar risk of UGIB. SN - 0017-5749 UR - https://www.unboundmedicine.com/medline/citation/16687434/Risk_of_upper_gastrointestinal_ulcer_bleeding_associated_with_selective_cyclo_oxygenase_2_inhibitors_traditional_non_aspirin_non_steroidal_anti_inflammatory_drugs_aspirin_and_combinations_ L2 - https://gut.bmj.com/lookup/pmidlookup?view=long&pmid=16687434 DB - PRIME DP - Unbound Medicine ER -