Association Between Nonsteroidal Anti-inflammatory Drugs and Upper Gastrointestinal Tract Bleeding/Perforation

Abstract

The elderly and patients with a history of peptic ulcer could benefit the most from a reduction in NSAID gastrotoxicity. Whenever possible, physicians may wish to recommend lower doses to reduce the UGIB risk associated with all individual NSAIDs, especially in the subgroup of patients with the greatest background risk.

Use of NSAIDs, COX‐2 inhibitors, and acetaminophen and associated coprescriptions of gastroprotective agents in an elderly population

“…They are mainly prescribed for treatment of arthritis and pain (1). The main concern with NSAIDs is their gastrointestinal (GI) safety (2)(3)(4)(5)(6)(7)(8)(9). NSAIDs can induce perforation, ulcer, and bleed (PUB) that may be fatal in some patients (4,10).…”

Meta-analysis: Acupuncture for Osteoarthritis of the Knee

“…Furthermore, many NSAIDs are associated with considerable side effects (9). Gastrointestinal bleeding, the most clinically substantial effect (10), causes approximately 2200 deaths and 12 000 emergency hospital admissions each year in the United Kingdom alone (11) and is of particular concern to older patients (10). Acetaminophen may have a better toxicity profile than that of NSAIDs (6).…”

Peptic Ulcer Disease in Older People

“…6 The risk of bleeding from peptic ulcer disease in nonselective NSAID users is approximately 5-fold but less for COX-2 inhibitors. 7 8 Gastrointestinal bleeding may be secondary to a drug's antiplatelet effect, which is supported by the finding that clopidogrel also increases the risk of upper gastrointestinal bleeding without ulceration. The combination of low-dose aspirin with esomeprazole has a lower rate of gastrointestinal bleeding than clopidogrel alone.…”