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Lower GI bleeding risk of nonsteroidal anti-inflammatory drugs and antiplatelet drug use alone and the effect of combined therapy.
Gastrointest Endosc. 2014 Dec; 80(6):1124-31.GE

Abstract

BACKGROUND

The effect of a combined antithrombotic drug regimen on lower GI bleeding (LGIB) remains unknown.

OBJECTIVE

To investigate the risk of LGIB associated with nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin, thienopyridine (ticlopidine or clopidogrel), or other antiplatelets used.

DESIGN

Prospective study.

SETTING

Emergency hospital, gastroenterology department.

PATIENTS

A cohort of 319 patients emergently hospitalized for acute, continuous, or frequent LGIB and 3358 patients with no bleeding on colonoscopy.

MAIN OUTCOME MEASUREMENTS

Odds ratios (ORs) for the risk of LGIB associated with drug exposure adjusting for age, sex, smoking, alcohol, medications, comorbidities, and GI symptom scores.

RESULTS

After considering antithrombotic drugs by dividing them into single- and combined-use, single use of nonselective NSAID or cyclooxygenase-2 inhibitor was independently associated with LGIB. The combined use of NSAIDs with low-dose aspirin (OR 4.3) or with other antiplatelets (OR 4.9) was more associated with LGIB than the use of NSAIDs alone (OR 2.3). Use of low-dose aspirin, thienopyridine, or other antiplatelets alone was not significantly associated with LGIB, but combined use of low-dose aspirin with thienopyridine (OR 2.2) or with other antiplatelets (OR 3.6) was associated with LGIB. Combined use of different NSAIDs carried a higher risk than single use (combined use, OR 4.9; single use, OR 2.3).

LIMITATIONS

Single-center study.

CONCLUSION

The use of nonselective or selective NSAIDs alone was associated with LGIB. Although antiplatelet use alone was not significantly associated with LGIB, combined use of NSAIDs with antiplatelets or of low-dose aspirin with thienopyridine or with nonthienopyridine antiplatelets was independently associated with LGIB.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.Department of Clinical Research and Informatics, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan.Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan.

Pub Type(s)

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

Language

eng

PubMed ID

25088922

Citation

Nagata, Naoyoshi, et al. "Lower GI Bleeding Risk of Nonsteroidal Anti-inflammatory Drugs and Antiplatelet Drug Use Alone and the Effect of Combined Therapy." Gastrointestinal Endoscopy, vol. 80, no. 6, 2014, pp. 1124-31.
Nagata N, Niikura R, Aoki T, et al. Lower GI bleeding risk of nonsteroidal anti-inflammatory drugs and antiplatelet drug use alone and the effect of combined therapy. Gastrointest Endosc. 2014;80(6):1124-31.
Nagata, N., Niikura, R., Aoki, T., Shimbo, T., Kishida, Y., Sekine, K., Tanaka, S., Okubo, H., Watanabe, K., Sakurai, T., Yokoi, C., Akiyama, J., Yanase, M., Mizokami, M., & Uemura, N. (2014). Lower GI bleeding risk of nonsteroidal anti-inflammatory drugs and antiplatelet drug use alone and the effect of combined therapy. Gastrointestinal Endoscopy, 80(6), 1124-31. https://doi.org/10.1016/j.gie.2014.06.039
Nagata N, et al. Lower GI Bleeding Risk of Nonsteroidal Anti-inflammatory Drugs and Antiplatelet Drug Use Alone and the Effect of Combined Therapy. Gastrointest Endosc. 2014;80(6):1124-31. PubMed PMID: 25088922.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lower GI bleeding risk of nonsteroidal anti-inflammatory drugs and antiplatelet drug use alone and the effect of combined therapy. AU - Nagata,Naoyoshi, AU - Niikura,Ryota, AU - Aoki,Tomonori, AU - Shimbo,Takuro, AU - Kishida,Yoshihiro, AU - Sekine,Katsunori, AU - Tanaka,Shohei, AU - Okubo,Hidetaka, AU - Watanabe,Kazuhiro, AU - Sakurai,Toshiyuki, AU - Yokoi,Chizu, AU - Akiyama,Junichi, AU - Yanase,Mikio, AU - Mizokami,Masashi, AU - Uemura,Naomi, Y1 - 2014/08/01/ PY - 2014/04/01/received PY - 2014/06/24/accepted PY - 2014/8/5/entrez PY - 2014/8/5/pubmed PY - 2015/7/29/medline SP - 1124 EP - 31 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 80 IS - 6 N2 - BACKGROUND: The effect of a combined antithrombotic drug regimen on lower GI bleeding (LGIB) remains unknown. OBJECTIVE: To investigate the risk of LGIB associated with nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin, thienopyridine (ticlopidine or clopidogrel), or other antiplatelets used. DESIGN: Prospective study. SETTING: Emergency hospital, gastroenterology department. PATIENTS: A cohort of 319 patients emergently hospitalized for acute, continuous, or frequent LGIB and 3358 patients with no bleeding on colonoscopy. MAIN OUTCOME MEASUREMENTS: Odds ratios (ORs) for the risk of LGIB associated with drug exposure adjusting for age, sex, smoking, alcohol, medications, comorbidities, and GI symptom scores. RESULTS: After considering antithrombotic drugs by dividing them into single- and combined-use, single use of nonselective NSAID or cyclooxygenase-2 inhibitor was independently associated with LGIB. The combined use of NSAIDs with low-dose aspirin (OR 4.3) or with other antiplatelets (OR 4.9) was more associated with LGIB than the use of NSAIDs alone (OR 2.3). Use of low-dose aspirin, thienopyridine, or other antiplatelets alone was not significantly associated with LGIB, but combined use of low-dose aspirin with thienopyridine (OR 2.2) or with other antiplatelets (OR 3.6) was associated with LGIB. Combined use of different NSAIDs carried a higher risk than single use (combined use, OR 4.9; single use, OR 2.3). LIMITATIONS: Single-center study. CONCLUSION: The use of nonselective or selective NSAIDs alone was associated with LGIB. Although antiplatelet use alone was not significantly associated with LGIB, combined use of NSAIDs with antiplatelets or of low-dose aspirin with thienopyridine or with nonthienopyridine antiplatelets was independently associated with LGIB. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/25088922/Lower_GI_bleeding_risk_of_nonsteroidal_anti_inflammatory_drugs_and_antiplatelet_drug_use_alone_and_the_effect_of_combined_therapy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(14)01930-0 DB - PRIME DP - Unbound Medicine ER -