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Colonic diverticular hemorrhage associated with the use of nonsteroidal anti-inflammatory drugs, low-dose aspirin, antiplatelet drugs, and dual therapy.
J Gastroenterol Hepatol. 2014 Oct; 29(10):1786-93.JG

Abstract

BACKGROUND AND AIM

The effects of various medications on lower gastrointestinal tract remains unknown. Here, we investigated the effects of nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin, and antiplatelet drugs associated with diverticular bleeding.

METHODS

This prospective study involved patients with diverticulosis who underwent colonoscopy. Alcohol and smoking, medications, and Charlson comorbidity index and Gastrointestinal Symptom Rating Scale scores were assessed. The medications evaluated were nine kinds of NSAIDs, two kinds of low-dose aspirin, 10 kinds of nonaspirin antiplatelet drugs, three kinds of anticoagulants, acetaminophen, and corticosteroids. Adjusted odds ratios (aOR) were estimated by a logistic regression model.

RESULTS

A total of 911 patients with non-bleeding diverticula (n = 758) and bleeding diverticula (n = 153) were enrolled. Independent risk factors were alcohol consumption (light drinker, aOR 3.4; ≥ moderate drinker, aOR 3.3), smoking index (≥ 400, aOR 2.0), NSAIDs (aOR 4.6), low-dose aspirin (aOR 1.9), and nonaspirin antiplatelet drugs (aOR 2.2). The drugs significantly associated with bleeding were loxoprofen (aOR 5.0), diclofenac (aOR 3.1), diclofenac suppository (aOR 8.0), etodolac (aOR 4.9), enteric-coated aspirin (aOR 3.9), buffered aspirin (aOR 9.9), clopidogrel (aOR 2.5), and cilostazol (aOR 7.3). Dual therapy carried a higher risk than monotherapy (single NSAID, aOR 3.6, P < 0.01; dual, aOR 23, P < 0.01; single antiplatelet drug, aOR 2.0, P < 0.01; dual, aOR 4.1, P < 0.01).

CONCLUSIONS

Besides alcohol and smoking, NSAIDs, low-dose aspirin, and antiplatelet drugs are risk factors for diverticular bleeding. The magnitude of risk may differ between different kinds of NSAIDs and antiplatelet drugs, and dual therapy with NSAIDs or antiplatelet drugs increases the risk of bleeding.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, International Clinical Research Center Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.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 available

Pub Type(s)

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

Language

eng

PubMed ID

24720424

Citation

Nagata, Naoyoshi, et al. "Colonic Diverticular Hemorrhage Associated With the Use of Nonsteroidal Anti-inflammatory Drugs, Low-dose Aspirin, Antiplatelet Drugs, and Dual Therapy." Journal of Gastroenterology and Hepatology, vol. 29, no. 10, 2014, pp. 1786-93.
Nagata N, Niikura R, Aoki T, et al. Colonic diverticular hemorrhage associated with the use of nonsteroidal anti-inflammatory drugs, low-dose aspirin, antiplatelet drugs, and dual therapy. J Gastroenterol Hepatol. 2014;29(10):1786-93.
Nagata, N., Niikura, R., Aoki, T., Shimbo, T., Kishida, Y., Sekine, K., Tanaka, S., Watanabe, K., Sakurai, T., Yokoi, C., Akiyama, J., Yanase, M., Mizokami, M., & Uemura, N. (2014). Colonic diverticular hemorrhage associated with the use of nonsteroidal anti-inflammatory drugs, low-dose aspirin, antiplatelet drugs, and dual therapy. Journal of Gastroenterology and Hepatology, 29(10), 1786-93. https://doi.org/10.1111/jgh.12595
Nagata N, et al. Colonic Diverticular Hemorrhage Associated With the Use of Nonsteroidal Anti-inflammatory Drugs, Low-dose Aspirin, Antiplatelet Drugs, and Dual Therapy. J Gastroenterol Hepatol. 2014;29(10):1786-93. PubMed PMID: 24720424.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Colonic diverticular hemorrhage associated with the use of nonsteroidal anti-inflammatory drugs, low-dose aspirin, antiplatelet drugs, and dual therapy. AU - Nagata,Naoyoshi, AU - Niikura,Ryota, AU - Aoki,Tomonori, AU - Shimbo,Takuro, AU - Kishida,Yoshihiro, AU - Sekine,Katsunori, AU - Tanaka,Shohei, AU - Watanabe,Kazuhiro, AU - Sakurai,Toshiyuki, AU - Yokoi,Chizu, AU - Akiyama,Junichi, AU - Yanase,Mikio, AU - Mizokami,Masashi, AU - Uemura,Naomi, PY - 2014/03/27/accepted PY - 2014/4/12/entrez PY - 2014/4/12/pubmed PY - 2015/8/11/medline KW - acetylsalicylic acid KW - acute lower gastrointestinal bleeding KW - antithrombotic drug KW - colonic diverticular bleeding KW - dual antiplatelet therapy SP - 1786 EP - 93 JF - Journal of gastroenterology and hepatology JO - J Gastroenterol Hepatol VL - 29 IS - 10 N2 - BACKGROUND AND AIM: The effects of various medications on lower gastrointestinal tract remains unknown. Here, we investigated the effects of nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin, and antiplatelet drugs associated with diverticular bleeding. METHODS: This prospective study involved patients with diverticulosis who underwent colonoscopy. Alcohol and smoking, medications, and Charlson comorbidity index and Gastrointestinal Symptom Rating Scale scores were assessed. The medications evaluated were nine kinds of NSAIDs, two kinds of low-dose aspirin, 10 kinds of nonaspirin antiplatelet drugs, three kinds of anticoagulants, acetaminophen, and corticosteroids. Adjusted odds ratios (aOR) were estimated by a logistic regression model. RESULTS: A total of 911 patients with non-bleeding diverticula (n = 758) and bleeding diverticula (n = 153) were enrolled. Independent risk factors were alcohol consumption (light drinker, aOR 3.4; ≥ moderate drinker, aOR 3.3), smoking index (≥ 400, aOR 2.0), NSAIDs (aOR 4.6), low-dose aspirin (aOR 1.9), and nonaspirin antiplatelet drugs (aOR 2.2). The drugs significantly associated with bleeding were loxoprofen (aOR 5.0), diclofenac (aOR 3.1), diclofenac suppository (aOR 8.0), etodolac (aOR 4.9), enteric-coated aspirin (aOR 3.9), buffered aspirin (aOR 9.9), clopidogrel (aOR 2.5), and cilostazol (aOR 7.3). Dual therapy carried a higher risk than monotherapy (single NSAID, aOR 3.6, P < 0.01; dual, aOR 23, P < 0.01; single antiplatelet drug, aOR 2.0, P < 0.01; dual, aOR 4.1, P < 0.01). CONCLUSIONS: Besides alcohol and smoking, NSAIDs, low-dose aspirin, and antiplatelet drugs are risk factors for diverticular bleeding. The magnitude of risk may differ between different kinds of NSAIDs and antiplatelet drugs, and dual therapy with NSAIDs or antiplatelet drugs increases the risk of bleeding. SN - 1440-1746 UR - https://www.unboundmedicine.com/medline/citation/24720424/Colonic_diverticular_hemorrhage_associated_with_the_use_of_nonsteroidal_anti_inflammatory_drugs_low_dose_aspirin_antiplatelet_drugs_and_dual_therapy_ L2 - https://doi.org/10.1111/jgh.12595 DB - PRIME DP - Unbound Medicine ER -