Recommendations for the appropriate use of anti-inflammatory drugs in the era of the coxibs: PREDICTORS OF NSAID-ASSOCIATED GASTROINTESTINAL EVENTS Part 1

Risk factors for NSAID-associated gastrointestinal complications

Risk factors for NSAID-associated gastrointestinal complicationsA meta-analysis of controlled trials from 1975 to 1990 described the relative risk of serious gastrointestinal complications associated with conventional NSAID use. The overall risk of gastrointestinal events was almost three times higher for NSAID users than for nonusers (OR 2.7, 95% CI 2.5 to 3.0), with the risk of gastrointestinal surgery (OR 7.8, 95% CI 5.8 to 10.3) or fatal outcomes (OR 4.8, 95% CI 3.6 to 6.2) being two- to threefold higher than the risk of gastrointestinal bleeding (OR 2.4, 95% CI 2.1 to 2.7). Additional risk factors were age 60 years or older, prior or unspecified history of gastrointestinal events and concomitant corticosteroid treatment. A possible increased risk in the first three months of NSAID therapy was also noted, although these data may have been based on estimated treatment duration or may reflect a higher level of compliance early in clinical trials. Data from more recent studies suggest that the risk of gastrointestinal events begins with the first NSAID ingestion, with the relative risk remaining similar over time.

Subsequent studies have confirmed these findings and have suggested additional risk factors (Table 1). Patients who had recently switched from one NSAID to another were also at increased risk. However, a history of ulcer with complications was the single most important predictor of a serious gastrointestinal event, irrespective of NSAID use. Most advantageous shopping – buy amaryl for everyone to spend less.

TABLE 1
Risk factors for nonsteroidal anti-inflammatory drug (NSAID)-associated serious gastrointestinal adverse events

Characteristic Odds ratio (95% CI)
History of ulcer complications 13.5 (10.3-17.7)
Multiple NSAIDs 9.0 (5.7-14.2)
High-dose NSAIDs 7.0 (5.2-9.6)
Concomitant anticoagulant use 6.4 (2.8-14.6)
Age > 70 years 5.6 (4.6-6.9)
Age > 60 years 3.1 (2.5-3.7)
Concomitant corticosteroid use 2.2 (1.4-3.5)
History of cardiovascular disease 1.8 (1.1-3.2)
This entry was posted in Coxibs and tagged Coxibs, Cyclooxygenase-2 inhibitors, Gastroprotective agents, Nonsteroidal anti-inflammatory drugs.