Original articleAlimentary tractRisk of Upper and Lower Gastrointestinal Bleeding in Patients Taking Nonsteroidal Anti-inflammatory Drugs, Antiplatelet Agents, or Anticoagulants
Section snippets
Study Design and Population
Case-control study with prospective case ascertainment and data collection was carried out between 2009 and mid-2013. Cases and controls were collected through a network of general hospitals integrated within the Spanish Association of Gastroenterology and the Biomedical Investigation Network Center of hepatic and digestive diseases (CIBERehd). Overall, eligible participants were 20–90 years old with non-variceal GI bleeding who had been free of liver disease, coagulation disorders, or
Demographics and Clinical Characteristics of Patients
A total of 1008 cases with GI bleeding and 1008 controls were collected from the participating centers. Men were 60.7% of cases and controls, and about 83.2% of the cases were aged >50 years. The mean age was 66.6 ± 16.0 and 65.6 ± 15.5 years in cases and controls, respectively. The corresponding figures for UGIB cases were 63.6 ± 16.7 years and for LGIB cases were 70.8 ± 13.8 years; also, 71.8% and 46.3% of patients, respectively, were men. Table 1 shows the frequency and crude estimate of RRs
Discussion
It is well-established that NSAIDs and ASA are associated with increased risk of UGIB,1, 2, 13, 14 but data on their effects on the risk of bleeding in lower GI tract are less clear, although the evidence has been growing in recent years.8, 9, 10 Also, the effect of non-aspirin APA drugs and anticoagulants on the risk of LGIB is much less explored. This study has evaluated the risk of GI bleeding associated with these compounds and compares the risks of either upper or lower GI bleeding in the
Acknowledgments
The authors thank the following people who helped in their work: M. A Aranguren, Hospital Donostia, San Sebastian, Spain; Judith Millastre, Hospital Universitario Miguel Servet, Zaragoza, Spain; Marta Gracia, Hospital Universitario Miguel Servet, Zaragoza, Spain; Ana Chaves, Hospital Costa del Sol, Marbella, Spain; Marta Ponce, Hospital La Fe, Valencia, Spain; Meritxell Sánchez-Lloansi, Corporació Sanitària Universitària, Sabadell, Spain; Pedro Lacarta, Hospital Clínico Universitario, Zaragoza,
References (20)
- et al.
Risk of upper gastrointestinal complications among users of traditional NSAIDs and COXIBs in the general population
Gastroenterology
(2007) - et al.
Side effects of nonsteroidal anti–inflammatory drugs on the small and large intestine in humans
Gastroenterology
(1993) - et al.
Visible small–intestinal mucosal injury in chronic NSAID users
Clin Gastroenterol Hepatol
(2005) - et al.
Long-term effects of nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 selective agents on the small bowel: a cross-sectional capsule enteroscopy study
Clin Gastroenterol Hepatol
(2007) - et al.
Clinical and endoscopic features of nonsteroidal anti-inflammatory drug-induced colonic ulcerations
Am J Gastroenterol
(2001) - et al.
Objective evidence of aspirin use in both ulcer and non–ulcer upper and lower gastrointestinal bleeding
Gastroenterology
(1992) - et al.
MEDAL Steering Committee: assessment of upper gastrointestinal safety of etoricoxib and diclofenac in patients with osteo-arthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) programme—a randomised comparison
Lancet
(2007) - et al.
Serious lower gastrointestinal clinical events with nonselective NSAID or coxib use
Gastroenterology
(2003) - et al.
Celecoxib versus omeprazole and diclofenac in patients with osteoarthritis and rheumatoid arthritis (CONDOR): a randomised trial
Lancet
(2010) - et al.
Low-dose aspirin affects the small bowel mucosa: results of a pilot study with a multidimensional assessment
Clin Gastroenterol Hepatol
(2009)
Cited by (199)
Biochemical evaluation with symptoms of gastrointestinal tract manifestations – A systemic review
2024, Journal of King Saud University - ScienceBiotransformation and metabolism of three methyl salicylate glycosides by gut microbiota in vitro
2023, Journal of Pharmaceutical and Biomedical AnalysisAspirin as a thromboprophylaxis agent after revision knee arthroplasty: A retrospective analysis
2023, Journal of OrthopaedicsEfficacy of Qingpeng ointment (a Tibetan medicine) for acute gouty arthritis: a multi-center, randomized, double-blind, placebo-controlled trial
2024, BMC Complementary Medicine and TherapiesClinical Evaluation of Side Effects Resulting from the Use of Aspirin Cardio
2024, AIP Conference Proceedings
Conflicts of interest These authors disclose the following: L. A. García Rodríguez has received research funding from AstraZeneca R&D and Bayer and has also received honoraria for serving on scientific advisory boards for Bayer. The institution of Angel Lanas has received funds from Bayer for investigator-initiated research and Angel Lanas has been advisor to Pfizer and Bayer and received speaking fees from Bayer and AstraZeneca. The remaining authors disclose no conflicts.
Funding The study was funded by the Official Spanish Agency, Instituto de Salud Carlos III, FIS grant PI08/1301, and the CIBERehd, which is supporting the salary of Patricia Carrera.