Clinical aspects of upper gastrointestinal bleeding associated with the use of nonsteroidal antiinflammatory drugs

László, András; Kelly, Judith P.; Kaufman, David W.; Sheehan, Jane; Rétsági, György; Wiholm, Bengt‐Erik; Koff, Raymond S.; Sundström, Anders; Shapiro, Samuel

doi:10.1016/s0002-9270(98)00093-8

Cited by 8 publications

(4 citation statements)

References 32 publications

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“…Despite the preventive effects of proton pump inhibitors on gastrointestinal toxicity from NSAIDs, it has been found that 70%-80% of users at risk for gastroduodenal complication does not receive gastroprotection [21,22] . The increased use of NSAIDs by the elderly explains partly the increased frequency observed in females in these ages in comparison with younger patients [23] . Severity of bleeding does not seem to be higher in the octogenarians group.…”

Section: Discussionmentioning

confidence: 99%

Acute upper gastrointestinal bleeding in octοgenarians: Clinical outcome and factors related to mortality

Theocharis¹,

Arvaniti²,

Assimakopoulos³

et al. 2008

WJG

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AIM:To evaluate the aetiology, clinical outcome and factors related to mortality of acute upper gastrointestinal bleeding (AUGIB) in octogenarians. METHODS:We reviewed the records of all patients over 65 years old who were hospitalised with AUGIB in two hospitals from January 2006 to December of 2006. Patients were divided into two groups: Group A (65-80 years old) and Group B (> 80 years old). RESULTS: Fo u r h u n d re d a n d s i x t e e n p a t i e n t s over 65 years of age were hospitalized because of AUGIB. Group A included 269 patients and Group B 147 patients. Co-morbidity was more common in octogenarians (P = 0.04). The main cause of bleeding was peptic ulcer in both groups. Rebleeding and emergency surgery were uncommon in octogenarians and not different from those in younger patients. In-hospital complications were more common in octogenarians (P = 0.05) and more patients died in the group of octogenarians compared to the younger age group (P = 0.02). Inability to perform endoscopic examination (P = 0.002), presence of high risk for rebleeding stigmata (P = 0.004), urea on admission (P = 0.036), rebleeding (P = 0.004) and presence of severe co-morbidity (P < 0.0001) were related to mortality. In multivariate analysis, only the presence of severe co-morbidity was independently related to mortality (P = 0.032). CONCLUSION: While rebleeding and emergency surgery rates are relatively low in octogenarians with AUGIB, the presence of severe co-morbidity is the main factor of adverse outcome.

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Section: Discussionmentioning

confidence: 99%

Acute upper gastrointestinal bleeding in octοgenarians: Clinical outcome and factors related to mortality

Theocharis¹,

Arvaniti²,

Assimakopoulos³

et al. 2008

WJG

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“…Data on the percentage of patients with a complicated UGI event who require inpatient management are available only from 1 large randomized controlled comparison of misoprostol and placebo in patients with RA taking NSAIDs (5), where 62.7% were managed in the hospital. The proportion of patients with a serious GI event who require surgery varies from 3.3% to 35.7% in cohort studies of patients hospitalized with a GI bleed (5, 22–29). Our baseline estimate (8.5%) was taken from a prospective study of 218 Atlanta patients receiving NSAIDs who had a proven ulcer responsible for upper GI bleeding (23).…”

Section: Methodsmentioning

confidence: 99%

“…Our baseline estimate (8.5%) was taken from a prospective study of 218 Atlanta patients receiving NSAIDs who had a proven ulcer responsible for upper GI bleeding (23). Estimates of the lower range were provided by a study of 1,026 patients in the US, Sweden, and Hungary who were hospitalized for a first episode of major UGI bleeding caused by gastric or duodenal ulcer (25); the upper range was provided by the Misoprostol Ulcer Complications Outcome Safety Assessment (MUCOSA) study (5, 30).…”

Section: Methodsmentioning

confidence: 99%

The cost effectiveness of rofecoxib and celecoxib in patients with osteoarthritis or rheumatoid arthritis

Maetzel¹,

Krahn²,

Naglie³

2003

Arthritis & Rheumatism

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Objective. To evaluate the cost effectiveness of the cyclooxygenase 2 (COX-2) selective nonsteroidal antiinflammatory drug (NSAID) rofecoxib compared with naproxen and the COX-2 NSAID celecoxib compared with ibuprofen and diclofenac. Methods. Cost-effectiveness analysis based on a 5-year Markov model. Probability estimates were derived from detailed data of 2 randomized trials and a systematic search of the medical literature. Utility estimates were obtained from 60 randomly selected members of the general public. Cost estimates were obtained from Canadian provincial databases. Incremental cost-effectiveness ratios were calculated for patients at average risk of upper gastrointestinal (UGI) events and for high-risk patients with a prior history of a UGI event. Subjects were patients with osteoarthritis or rheumatoid arthritis (RA) where a decision has been made to treat with NSAIDs but who do not require low-dose aspirin. Main outcome measures were proportion of patients with clinical or complicated UGI events, quality-adjusted life expectancy, and life expectancy. Results. Evaluation of rofecoxib versus naproxen in patients with RA at average risk resulted in costs per qualityadjusted life year (QALY) gained of $Can271,188. Celecoxib was dominated by diclofenac in average-risk patients. Both rofecoxib and celecoxib are cost-effective in high-risk patients. Analyses by age groups and assuming a threshold of Can$50,000 per QALY gained, suggest that rofecoxib or celecoxib would be cost-effective in patients aged over 76 and 81, respectively, without additional risk factors. Conclusion. Both rofecoxib and celecoxib are economically attractive in high risk and elderly patients. They are not economically attractive in patients at average risk. Coprescription of proton-pump inhibitors with COX-2 NSAIDs is not economically attractive for patients at high risk.

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“…For each hospitalization, the files of the HDR include information on the personal identification number of the patient, date of discharge, and up to 20 discharge diagnoses, coded according to the Danish version of the International Classification of Diseases, 8th revision until the end of 1993 and 10th revision thereafter. UGIBs were defined as a diagnosis of esophagitis (ICD- 8 …”

Section: Ugib Case Ascertainmentmentioning

confidence: 99%

Outcome of upper gastro-intestinal bleeding and use of ibuprofen versus paracetamol

et al. 2004

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Clinical aspects of upper gastrointestinal bleeding associated with the use of nonsteroidal antiinflammatory drugs

Abstract: There are no important differences in the clinical presentation of major UGIB according to whether or not an individual is an NSAID user. An important finding is the frequent absence of preceding symptoms in patients with major UGIB, regardless of NSAID use.

Cited by 8 publications

References 32 publications

Acute upper gastrointestinal bleeding in octοgenarians: Clinical outcome and factors related to mortality

Acute upper gastrointestinal bleeding in octοgenarians: Clinical outcome and factors related to mortality

The cost effectiveness of rofecoxib and celecoxib in patients with osteoarthritis or rheumatoid arthritis

Outcome of upper gastro-intestinal bleeding and use of ibuprofen versus paracetamol

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