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Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with nonsteroidal anti-inflammatory drugs, antiplatelet agents, and anticoagulants.
Am J Gastroenterol. 2007 Mar; 102(3):507-15.AJ

Abstract

OBJECTIVES

After the withdrawal of some cyclooxygenase-2 (COX-2) selective inhibitors, traditional nonsteroidal anti-inflammatory drug (NSAID) use has increased, but without additional prevention strategies against upper gastrointestinal (GI) complications in many cases. Here, we report the effect of antisecretory drugs and nitrates on the risk of upper GI peptic ulcer bleeding (UGIB) associated with nonselective NSAIDs, aspirin, antiplatelet agents, and anticoagulants.

METHODS

This case-control study matched 2,777 consecutive patients with UGIB (confirmed by endoscopy) with 5,532 controls (2:1). Adjusted relative risks (RR) of UGIB are reported.

RESULTS

Proton pump inhibitors (PPIs) (RR 0.33, 95% confidence interval [CI] 0.27-0.39), H2-receptor antagonists (H2-RAs) (RR 0.65, 95% CI 0.50-0.85), and nitrates (RR 0.52, 95% CI 0.38-0.70) reduced UGIB risk. PPI use was associated with greater reductions among both traditional NSAID (RR 0.13, 95% CI 0.09-0.19 vs RR 0.30, 95% CI 0.17-0.53 with H2-RAs; RR 0.48, 95% CI 0.19-1.24 with nitrates) and low-dose aspirin users (RR 0.32, 95% CI 0.22-0.51 vs RR 0.40, 95% CI 0.19-0.73 with H2-RA; RR 0.69, 95% CI 0.36-1.04 with nitrates), and among patients taking clopidogrel (RR 0.19, 95% CI 0.07-0.49). For patients taking anticoagulants, use of nitrates, H2-RA, or PPIs was not associated with a significant effect on UGIB risk.

CONCLUSION

Antisecretory agent or nitrate treatment is associated with reduced UGIB RR in patients taking NSAID or aspirin. Only PPI therapy was associated with a marked, consistent risk reduction among patients receiving all types of agents (including nonaspirin antiplatelet agents). Protection was not apparent in patients taking anticoagulants.

Authors+Show Affiliations

Servicio de Aparato Digestivo, Hospital Clínico Zaragoza, Ciber Hepad, Zaragoza, Spain.No 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

17338735

Citation

Lanas, Angel, et al. "Effect of Antisecretory Drugs and Nitrates On the Risk of Ulcer Bleeding Associated With Nonsteroidal Anti-inflammatory Drugs, Antiplatelet Agents, and Anticoagulants." The American Journal of Gastroenterology, vol. 102, no. 3, 2007, pp. 507-15.
Lanas A, García-Rodríguez LA, Arroyo MT, et al. Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with nonsteroidal anti-inflammatory drugs, antiplatelet agents, and anticoagulants. Am J Gastroenterol. 2007;102(3):507-15.
Lanas, A., García-Rodríguez, L. A., Arroyo, M. T., Bujanda, L., Gomollón, F., Forné, M., Aleman, S., Nicolas, D., Feu, F., González-Pérez, A., Borda, A., Castro, M., Poveda, M. J., & Arenas, J. (2007). Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with nonsteroidal anti-inflammatory drugs, antiplatelet agents, and anticoagulants. The American Journal of Gastroenterology, 102(3), 507-15.
Lanas A, et al. Effect of Antisecretory Drugs and Nitrates On the Risk of Ulcer Bleeding Associated With Nonsteroidal Anti-inflammatory Drugs, Antiplatelet Agents, and Anticoagulants. Am J Gastroenterol. 2007;102(3):507-15. PubMed PMID: 17338735.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with nonsteroidal anti-inflammatory drugs, antiplatelet agents, and anticoagulants. AU - Lanas,Angel, AU - García-Rodríguez,Luis A, AU - Arroyo,Maria T, AU - Bujanda,Luis, AU - Gomollón,Fernando, AU - Forné,Montserrat, AU - Aleman,Sofía, AU - Nicolas,David, AU - Feu,Faust, AU - González-Pérez,Antonio, AU - Borda,Ana, AU - Castro,Manuel, AU - Poveda,Maria Jose, AU - Arenas,Juan, AU - ,, PY - 2007/3/7/pubmed PY - 2007/4/27/medline PY - 2007/3/7/entrez SP - 507 EP - 15 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 102 IS - 3 N2 - OBJECTIVES: After the withdrawal of some cyclooxygenase-2 (COX-2) selective inhibitors, traditional nonsteroidal anti-inflammatory drug (NSAID) use has increased, but without additional prevention strategies against upper gastrointestinal (GI) complications in many cases. Here, we report the effect of antisecretory drugs and nitrates on the risk of upper GI peptic ulcer bleeding (UGIB) associated with nonselective NSAIDs, aspirin, antiplatelet agents, and anticoagulants. METHODS: This case-control study matched 2,777 consecutive patients with UGIB (confirmed by endoscopy) with 5,532 controls (2:1). Adjusted relative risks (RR) of UGIB are reported. RESULTS: Proton pump inhibitors (PPIs) (RR 0.33, 95% confidence interval [CI] 0.27-0.39), H2-receptor antagonists (H2-RAs) (RR 0.65, 95% CI 0.50-0.85), and nitrates (RR 0.52, 95% CI 0.38-0.70) reduced UGIB risk. PPI use was associated with greater reductions among both traditional NSAID (RR 0.13, 95% CI 0.09-0.19 vs RR 0.30, 95% CI 0.17-0.53 with H2-RAs; RR 0.48, 95% CI 0.19-1.24 with nitrates) and low-dose aspirin users (RR 0.32, 95% CI 0.22-0.51 vs RR 0.40, 95% CI 0.19-0.73 with H2-RA; RR 0.69, 95% CI 0.36-1.04 with nitrates), and among patients taking clopidogrel (RR 0.19, 95% CI 0.07-0.49). For patients taking anticoagulants, use of nitrates, H2-RA, or PPIs was not associated with a significant effect on UGIB risk. CONCLUSION: Antisecretory agent or nitrate treatment is associated with reduced UGIB RR in patients taking NSAID or aspirin. Only PPI therapy was associated with a marked, consistent risk reduction among patients receiving all types of agents (including nonaspirin antiplatelet agents). Protection was not apparent in patients taking anticoagulants. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/17338735/Effect_of_antisecretory_drugs_and_nitrates_on_the_risk_of_ulcer_bleeding_associated_with_nonsteroidal_anti_inflammatory_drugs_antiplatelet_agents_and_anticoagulants_ L2 - https://Insights.ovid.com/pubmed?pmid=17338735 DB - PRIME DP - Unbound Medicine ER -