Aspirin and bleeding peptic ulcers in the elderly.

Faulkner, Gail; Prichard, PJ; Somerville, K. W.; Langman, M. J. S.

doi:10.1136/bmj.297.6659.1311

Cited by 108 publications

(38 citation statements)

References 16 publications

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“…The lower overall risk with aspirin compared with NSAIDs is not unexpected, since these were usually not antiinflammatory doses. Similar risk estimates have been reported by Faulkner et a1 (16).…”

Section: Discussionsupporting

confidence: 89%

Variation in the risk of peptic ulcer complications with nonsteroidal antiinflammatory drug therapy

Savage

Moller

Ballantyne

et al. 1993

Arthritis & Rheumatism

124

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Objective. To assess the risk of perforation or hemorrhage of peptic ulcer on treatment with nonsteroidal antiinflammatory drugs (NSAIDs), both as a class and as individual agents.Methods. A case-control study of medication histories in 494 patients and 972 matched control subjects.Results. The increase in risk (odds ratio) with NSAID therapy was 5.1 times the risk in controls. The odds ratio for piroxicam was 6.3 (95% confidence interval [CI] 3.3-12.0), as compared with 2.9 for diclofenac, ketoprofen, and sulindac combined (95% CI 2.0-4.2). The effect of other risk factors was also considered, and the adjusted odds ratios were 4.1 for all NSAIDs, 6.4 (95% CI 2.8-15.0) for piroxicam, and 3.3 (95% CI 2.G5.5) for diclofenac, ketoprofen, and sulindac combined.Conclusion. in other studies. There appear to be differences in risk between agents.It is well known that treatment with nonsteroidal antiinflammatory drugs (NSAIDs) is associated with unwanted gastrointestinal (GI) side effects. Retrospective studies have suggested that NSAIDs are associated with an increased risk of perforated peptic ulcer (1,2), and case-control studies have shown a risk factor of 2-4 for hemorrhage of peptic ulcers (3,4) in patients aged 60 years and over. Data from the UK Committee on Safety of Medicines ( 5 ) showed that for the NSAIDs currently available in New Zealand, reports of GI reactions ranged from 21 to 75 per million prescriptions.To ascertain the relative risks with the various NSAIDs, a case-control study of hemorrhage and perforation of peptic ulcer was begun early in 1986. The aim of this study was to confirm an increased risk of complications of peptic ulcer with NSAIDs and to determine whether there are significant differences between the available agents. PATIENTS AND METHODSSelection of patient population. It was estimated that to detect a 3-fold underrepresentation or a 2-fold overrepresentation in the case group of individual NSAIDs having 15% or more of the market share, and assuming an overall increase in risk of 3-fold, the study would require 450 index patients and 900 control subjects (a = 0.05, p = 1 -0.8). To this end, patients in Christchurch and surrounding areas (population 350,000) who were admitted to the hospital because of GI hemorrhage or possible perforation were identified within 24 hours by either the admitting diagnosis or the findings after admission. All such cases are admitted to

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Section: Discussionsupporting

confidence: 89%

Variation in the risk of peptic ulcer complications with nonsteroidal antiinflammatory drug therapy

Savage

Moller

Ballantyne

et al. 1993

Arthritis & Rheumatism

124

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“…Our results demonstrated that risk of hemorrhage is higher in ASA using patients than NSAIDS using patients. Faulkner et al (29) reported a 3-fold increased rate of hospitalization for ulcer complications in patients using ASA compared to with those taking NSAIDs.…”

Section: Discussionmentioning

confidence: 99%

Atherosclerosis and acetylsalicylic acid are independent risk factors for hemorrhage in patients with gastric or duodenal ulcer

Özdil¹,

Coşar²,

Akkız³

et al. 2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Üst gastrointestinal (Gİ) endoskopide gastrik ve/veya duodenal ülser saptanan vakalarda ülser kanaması için risk faktörleri araştırıldı. Yöntemler: Üst Gİ endoskopisinde duodenum ve gastrik ülser saptanan 350 vakanın (226 Erkek, 124 Kadın) dosyalarından retrospektif analiz yapıldı. İncelenen 92 vakada endoskopi sırasında Gİ kanama saptanmıştı. Kanaması olan ve olmayan hastaların tümünde nonsteroidal antienflamatuvar ilaç (NSAID) ve asetil salisilik asit (ASA) kullanımı ile koroner arter hastalığı (KAH) varlığı araştırıldı. Sonuçlar Ki-kare testi ve lojistik regresyon analizi ile değerlendirildi. Bulgular: Vakaların yaş ortalaması 50.4±15.7 (25-82) yıl idi. Doksan iki vakada (%26) gastrik veya duodenal ülsere bağlı kanama görüldü. Kanamalı hastalarda yaş ortalaması 64.6±11.4/ yıl, kanama olmayanlarda 45.7±13.9/yıl idi. Ülser kanaması olan vakalarda ASA kullanımı daha fazlaydı (NSAID, n=35 (%40); ASA, n=51 (%60); p=0.035). Ülseri olan kadınların %20'sinde kanama görülürken, erkeklerin %28'inde kanama görül-dü (p=0.055). Kanama riski KAH'lı vakalarda (OR:24.75, %95 güven aralığı (GA)=1.6-96.7, p=0.001), ASA (OR:9.76, %95 GA=2.1-37.5, p=0.021), NSAID (OR:4.72, %95 GA=1.1-16.5 p=0.032), yaş (OR:11.59, %95 GA=2.7-12.1, p=0.001), erkek cinsiyet için (OR:2.56, %95 GA=0.8, 9.6, p=0.052) olarak belirlendi. Sonuç: İleri yaş, ateroskleroz, erkek cinsiyet ve NSAİD (özellikle aspirin) kullanımı gastrik ve/veya duodenal ülserli hastalarda üst Gİ kanaması bakımından majör risk faktörleridir. (Anadolu Kardiyol Derg 2011 1: 53-6) Anahtar kelimeler: Aspirin, koroner arter hastalığı, üst gastrointestinal kanama, nonsteroidal anti-inflamatuvar ilaç, lojistik regresyon analizi ABSTRACT Objective: Risk factors for hemorrhage due to gastric and/or duodenal ulcer in patients diagnosed by upper gastrointestinal (GI) endoscopy were investigated in the present study. Methods: Medical records of 350 patients (226 males, 124 females) diagnosed as duodenal or gastric ulcers by GI endoscopy in the gastroenterology clinic were scanned retrospectively. Upper GI hemorrhage was detected in 92 patients by upper endoscopic examination. The medical history of non-steroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (ASA) usage and the presence of coronary artery disease (CAD) were investigated in all patients with or without hemorrhage. Results were evaluated by Chi-square test and logistic regression analysis. Results: The mean age of the patients was 50.4±15.7 years (range: 25 to 82 years). Hemorrhage due to gastric or duodenal ulcer was identified in 92 patients (26%). Mean age was 64.6±11.4 years in patients with hemorrhage and 45.7±13.9 years in patients without hemorrhage. ASA usage was more common than NSAID in patients with ulcer hemorrhage (NSAID usage n=35 (40%); ASA usage n=51 (60%); p=0.035). Hemorrhage was reported in 20% of the females and in 28% of the males who have ulcer (p=0.055). Risk factors for hemorrhage were CAD (OR:24.75, 95% CI=1.6-96.7, p=0.001), ASA usage (OR:9.76, 95% CI=2.1-37.5, p=0.021), NSAID us...

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“…Based on clinical and control studies performed in the years 1970-1995 Andrade et al calculated an excess mortality index for 5 most commonly occurring side effects associated with the use of non-narcotic analgesics (metamizole sodium, paracetamol, propyphenazone) and nonsteroidal anti-inflammatory drugs (ketoprophen, acetylsalicylic acid, diclofenac, naproxen, indomethacin) (23)(24)(25)(26)(27)(28)(29)(30)(31)(32). The authors analyzed median excess mortality due to agranulocytosis, anaphylaxis, aplastic anemia, gastrointestinal bleeding as well as Stevens-Johnson syndrome and toxic epidermal necrolysis.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, aplastic anemia and agranulocytosis (particularly associated with indomethacin) were also mentioned. Mortality rate due to use of nonsteroid anti-inflammatory drugs that was cal-culated for 10 6 patients was estimated 0.2 for paracetamol and 0.25 for metamizole sodium (26)(27)(28)(29)(30)(31)(32).…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Analgesic Effect of Metamizole Sodium in Patients Operated on for Goitre

Srebrzyński

Ziółkowski

Płużańska

et al. 2008

Polish Journal of Surgery

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The aim of the study was to evaluate the analgesic effect of metamizole sodium administered intravenously during the day after surgery in patients operated on for nodular goitre -using the 11-point NAS scale (Numeric Analog Scale). Material and methods. The study was comprised of 114 patients who had undergone surgery for nontoxic: 84 (73.7%) or toxic: 30 (26.3%) nodular goitre. The goitre size, according to the WHO classification ranged between III and I° (2). I° goitre was found in 31 (27%) patients, II° goitre -in 46 (40.4%) patients and III° goitre -in 37 (32.4%) patients. The age of patients ranged between 22 and 75 years (median 53, IQR 43-61). The goitre was localized in the neck in 103 (90.4%) patients and it partially reached the superior aperture of the thorax with its lower poles in 11 (9.6%) patients. Patients with coexisting diseases such as diabetes mellitus or peripheral neuropathy were excluded from the study. Patients were randomly assigned to 4 groups. Group I included 38 subjects in whom metamizole sodium was applied at a dose of 1 g intravenously every 6 hours for a day after surgery; the first dose was administered at the moment of surgical wound closure. Group II included 37 patients in whom metamizole sodium was applied according to the above-mentioned regimen and, additionally the surgical wound was injected with 10 ml of bupivacaine 0.25%. Group III consisted of 36 patients in whom 1 g of metamizole was first administered intravenously thirty minutes before surgery and the subsequent doses were systematically repeated at time intervals of 6 hours (preemptive analgesia), avoiding buvacaine wound infiltration. Group IV included 40 patients in whom ketoprophen was administered intravenously at a dose of 0.1 g every 6 hours for a day after the procedure. Surgical wounds were not injected with buvacaine in these patients, similarly as in groups III and I. In case of severe pain patients could additionally receive morphine 1 mg on-demand. Results. Pain intensity was analyzed every 6 hours on NAS scale and pain scores ranged from 1 to 5.5. At all time points, the highest pain intensity scores were found in patients who received metamizole as monotherapy (group I) or ketoprofen (group IV), while the lowest were found in the groups where surgical wound was additionally injected with bupivacaine solution (group II) or additional metamizole dose was used before the procedure (group III). Patients from group II rated their pain intensity as slightly higher or similar to that in group III (statistically insiginficant). Similarly patients from group I had pain scores slightly higher or similar to scores reported in group IV (statistically insiginficant). Conclusions. 1. The most intense pain was observed during the first 12 hours after thyroid surgery. 2. Administration of metamizole sodium according to the regimen that was applied in groups II and III provided sufficient analgesia. 3. Infiltration of the surgical wound with buvacaine or administration of an additional dose of metamizole sodium prior ...

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Aspirin and bleeding peptic ulcers in the elderly.

Cited by 108 publications

References 16 publications

Variation in the risk of peptic ulcer complications with nonsteroidal antiinflammatory drug therapy

Variation in the risk of peptic ulcer complications with nonsteroidal antiinflammatory drug therapy

Atherosclerosis and acetylsalicylic acid are independent risk factors for hemorrhage in patients with gastric or duodenal ulcer

Analysis of the Analgesic Effect of Metamizole Sodium in Patients Operated on for Goitre

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