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Lower GI bleeding risk of nonsteroidal anti-inflammatory drugs and antiplatelet drug use alone and the effect of combined therapy.
- Source :
-
Gastrointestinal endoscopy [Gastrointest Endosc] 2014 Dec; Vol. 80 (6), pp. 1124-31. Date of Electronic Publication: 2014 Aug 01. - Publication Year :
- 2014
-
Abstract
- Background: The effect of a combined antithrombotic drug regimen on lower GI bleeding (LGIB) remains unknown.<br />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.<br />Design: Prospective study.<br />Setting: Emergency hospital, gastroenterology department.<br />Patients: A cohort of 319 patients emergently hospitalized for acute, continuous, or frequent LGIB and 3358 patients with no bleeding on colonoscopy.<br />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.<br />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).<br />Limitations: Single-center study.<br />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.<br /> (Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aspirin administration & dosage
Case-Control Studies
Clopidogrel
Colonic Diseases complications
Colonoscopy
Cyclooxygenase 2 Inhibitors adverse effects
Drug Therapy, Combination adverse effects
Female
Gastrointestinal Hemorrhage etiology
Humans
Male
Middle Aged
Prospective Studies
Rectal Diseases complications
Risk Factors
Ticlopidine adverse effects
Ticlopidine analogs & derivatives
Anti-Inflammatory Agents, Non-Steroidal adverse effects
Aspirin adverse effects
Gastrointestinal Hemorrhage chemically induced
Platelet Aggregation Inhibitors adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6779
- Volume :
- 80
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Gastrointestinal endoscopy
- Publication Type :
- Academic Journal
- Accession number :
- 25088922
- Full Text :
- https://doi.org/10.1016/j.gie.2014.06.039