Estrategia clínica para la prevención de los efectos adversos sobre el tracto digestivo de los antiinflamatorios no esteroideos

Lanas, Ángel; Martı́n-Mola, Emilio; Ponce, J.; Moreno-Navarro, Fernando; Piqué, JM; Blanco, FJ

doi:10.1016/s0210-5705(03)70400-2

Cited by 32 publications

(7 citation statements)

References 120 publications

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“…Based on the previous researches, the most relevant risk factors of developing NSAID-induced GI bleeding summarized are: [18–22] age ≥65 years [23,24] (age >60 years for some scientific associations [20,25] ); prior occurrence or history of peptic ulcer disease, including previous GI bleeding associated with NSAIDs; [26] and concomitant use of other medications—systemic corticoids, [23] oral anticoagulants, [27] clopidogrel or ticlopidine, [28] alendronate, [29] or other NSAIDs, including low-dose acetylsalicylic acid (80–325 mg/d). [30] Risk assessment is crucial for managing NSAIDs-induced GI damage.…”

Section: Introductionmentioning

confidence: 99%

Risk factors associated with nonsteroidal anti-inflammatory drugs (NSAIDs)-induced gastrointestinal bleeding resulting on people over 60 years old in Beijing

2018

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Gastrointestinal (GI) bleeding is an unwanted side effect common to all chemical types of nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in elderly people. However, the risk factors of GI bleeding associated with NSAIDs for elderly people remain unknown. This study aims to evaluate the risks of GI bleeding associated with NSAIDs in 4728 elderly people over 60 years old based on database from a hospital in Beijing.This retrospective hospital-based study included 4728 patients over 60 years old prescribed with NSAIDs, of which 928 patients had GI bleeding and 3800 did not have. Odds ratios (OR) for the risk of GI bleeding associated with NSAIDs were determined by logistic regression analysis. Mean Decrease Gini (MDG) involved in random forest algorithm was used to rank the associated factors with GI bleeding.In multivariate analysis, family history of GI bleeding (OR, 3.348; P = .000), history of peptic ulcers (OR, 4.068; P = .000), history of cardiovascular and cerebrovascular disease (OR, 1.476; P = .001), diabetes mellitus (OR, 1.408; P = .000), antiplatelet drugs (OR, 3.106; P = .000), Helicobacter pylori infection (OR, 1.312; P = .001), cholesterol level (OR, 0.516; P = .000), upper abdominal discomfort (OR, 3.467; P = .000), anorexia (OR, 2.038; P = .000), and NSAIDs used for 0.5 to 3 months (OR, 0.780; P = .000) were associated with GI bleeding. After ranked the MDG of each factor, the top 5 ranked factors associated with GI bleeding were melena, hematemesis, antiplatelet drugs, cholesterol level, and upper abdominal discomfort.We found that family history of GI bleeding, history of peptic ulcers, history of cardiovascular and cerebrovascular disease, diabetes mellitus, antiplatelet drugs, Helicobacter pylori infection, hypocholesterolemia, and NSAIDs used for 0.5 to 3 months were independent risk factors for GI bleeding on people over 60 years old. Meanwhile, upper abdominal discomfort might be the predictor of GI bleeding associated with NSAIDs elderly users.

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Section: Introductionmentioning

confidence: 99%

Risk factors associated with nonsteroidal anti-inflammatory drugs (NSAIDs)-induced gastrointestinal bleeding resulting on people over 60 years old in Beijing

2018

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“…Se ha demostrado que la edad superior a 60 años es por sí sola un factor de riesgo 63 (nivel de evidencia I) y con la evidencia disponible en la actualidad se sabe que a mayor edad mayor riesgo 117,118,142 desde el punto de corte de 60 años y siendo ostensible a partir de los 70 años 117,118 . En la última revisión de UpToDate 68 , o recomendaciones nacionales como la Asociación Española de Gastroenterología 64 , se ha establecido el punto de corte en 60 años. Algunos estudios o guías fijan sus recomendaciones a partir de los 65 años.…”

Section: Criterios Para Clasificar a Un Paciente En Los Tres Niveles ...unclassified

“…La edad superior a 60 años es factor de riesgo para la aparición de complicaciones gastrointestinales en pacientes que toman AINE (nivel de evidencia III) 64 .…”

Section: Contenido Edadunclassified

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Prescripciones de IBP a los pacientes de una oficina de farmacia, análisis de su ajuste a las recomendaciones y evidencias científicas publicadas

2021

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A. En pacientes menores de 60 años, sin síntomas de patología digestiva, y sin factores de riesgo de úlcera péptica ni HDA, a los que se paute tratamiento con AINE de forma aguda, se recomienda no asociar IBP. B. Se propone utilizar IBP en pacientes menores de 60 años con alto riesgo de HDA en tratamiento con AINE de forma aguda. PACIENTE MENOR DE 60 AÑOS CON TRATAMIENTO CRÓNICO CON AINE.A. En pacientes menores de 60 años, sin síntomas de patología digestiva y sin factores de riesgo de úlcera péptica ni HDA, que tengan pautado tratamiento con AINE de forma crónica, se recomienda no asociar IBP. B. Se propone usar IBP en pacientes menores de 60 años, con factores de riesgo de HDA, en tratamiento con AINE de forma crónica. PACIENTE MAYOR DE 60 AÑOS CON TRATAMIENTO AGUDO CON AINEB. En pacientes mayores de 60 años, sin síntomas de patología digestiva y sin antecedentes de úlcera péptica ni HDA, a los que se pauten AINE de forma aguda, se propone asociar IBP.A. En pacientes mayores de 60 años, sin síntomas de patología digestiva y sin antecedentes de úlcera péptica ni HDA, en tratamiento con AAS que se pauten inhibidores COX-2 de forma aguda concomitantemente, se recomienda asociar IBP.C. En pacientes mayores de 60 años, sin síntomas de patología digestiva y sin antecedentes de úlcera péptica ni HDA, en tratamiento con anticoagulantes que se pauten inhibidores COX-2 de forma aguda concomitantemente, se sugiere asociar IBP. PACIENTE MAYOR DE 60 AÑOS EN TRATAMIENTO CRÓNICO CON AINEA. Se recomienda prescribir un IBP en pacientes mayores de 60 años a los que se pauta AINE de forma prolongada.A. Se recomienda asociar un IBP en pacientes mayores de 60 años con antecedentes de HDA a los que se pauta un inhibidor COX-2 de forma crónica.GUÍA DE REFERENCIA RÁPIDA 16 PACIENTES EN TRATAMIENTO CRÓNICO CON ANALGESICO NO AINEA. No se recomienda gastroprotección en pacientes en tratamiento con paracetamol a dosis de hasta 4 g/día.C. En pacientes que toman paracetamol y AINE se sugiere realizar la gastroprotección que esté recomendada por la utilización de los AINE, independientemente de la dosis de paracetamol.C. En pacientes que toman paracetamol e inhibidores COX-2 se sugiere realizar la gastroprotección que esté recomendada por la utilización de los inhibidores COX-2, independientemente de la dosis de paracetamol.C. Metamizol, pero no tramadol ni propifenazona, parece inducir un ligero incremento del riesgo de hemorragia digestiva alta. Podría sugerirse la utilización de IBP en pacientes de alto riesgo. PACIENTES EN TRATAMIENTO CRÓNICO CON ANTIAGREGANTESA. En pacientes menores de 60 años, sin síntomas de patología digestiva y sin antecedentes de úlcera péptica ni HDA, en tratamiento crónico con antiagregantes/AAS, se recomienda no asociar IBP. B. En pacientes mayores de 60 años en tratamiento crónico con antiagregantes/AAS, se propone asociar IBP.A. En pacientes de cualquier edad en tratamiento con bajas dosis de AAS e historia previa de úlcera o sangrado gastrointestinal se recomienda asociar un IBP.A. En pacientes en tratamiento...

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“…The fact that a high usage is fully justified in the treatment of GERD and NSAIDrelated gastric disease does not exclude inappropriate prescribing. This is particularly apparent in the prevention of NSAID-related gastric injury, where indications are both excessive and incorrect (16), as they do not comply with clinical practice recommendations, including Spanish guidelines (17). In this setting polypharmacy prescriptions not including any gastrolesive drugs stand out.…”

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confidence: 99%

Rationalizing the use of PPIs: An unresolved matter

Ponce¹,

Esplugues

2013

Rev. esp. enferm. dig.

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The abnormally high use of proton-pump inhibitors (PPIs) has been repeatedly denounced for many years (1), and attention has been drawn towards the economic burden it represents (2,3). Multiple scientific publications have reported this problem in many countries. In the present issue of the Journal an observational, prospective study based on a survey to analyze the inappropriate (not recommended by clinical guidelines) indication of chronic PPI use (daily for over one year) in outpatients seen at a specialty hospital in Mexico is reported (4). The authors find an overall rate of inappropriateness of 35.3 %, a figure within the lower range of those reported, which exceed 60 % in many countries including Australia (5,6), United Kingdom (7), and Greece (8), and in four studies performed in Spain (9,10-12). All these studies discuss oral therapy with PPIs, but inappropriateness is also very high (above 75 %) in terms of dosage and length of intravenous therapy (13).The introduction of antisecretory agents in clinical practice, initially H 2 antagonists and then PPIs, has brought in the treatment of conditions associated with gastric acid secretion. The indisputable greater effectiveness of PPIs makes them preferable progress to H 2 antagonists . In a study that examined the indication of antisecretory agents at hospital admission and discharge for gastro-esophageal reflux disease (GERD) and peptic ulcer, two conditions where prescription is appropriate, PPIs were chosen in over 95 % of cases (14).PPI prescription is quantitatively high because of factors inherent to these drugs (high therapeutic efficacy and safety) and the high prevalence of diseases where they are appropriately indicated. GERD -the paradigm here-accounts for almost all appropriate PPI prescriptions for chronic use, and is followed by the prophylaxis of gastric disease by non-steroidal anti-inflammatory drugs (NSAIDs). Sánchez Cuén et al. (4) note that GERD is the most common appropriate indication (31,3 %), representing over 70 % of all appropriate indications.Disease-related factors that account for a high use of PPIs include the high prevalence and chronic nature of GERD, as well as the frequent need for prophylaxis of NSAID-related gastropathy, which is presumably increasing (population ageing associated with comorbidity and a higher number of therapies representing risk factors, including anticoagulants, antiaggregants, etc.). These factors justify a high number of prescriptions for continous PPI therapy, as reported by health agencies. According to the latest official data, PPI use in Spain increased by 227 % during the 2004-2010 period; however, the cost for the Treasury only increased by 21.3 %, from €516 to €626 million, which is increased, nevertheless, a significant sum of money. It is of note that the increased expense principally in the first two years and has remained virtually identical (€626 million in 2006) during the last five years of the mentioned above period. Thus, costs per prescription have decreased, most likely

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Estrategia clínica para la prevención de los efectos adversos sobre el tracto digestivo de los antiinflamatorios no esteroideos

Cited by 32 publications

References 120 publications

Risk factors associated with nonsteroidal anti-inflammatory drugs (NSAIDs)-induced gastrointestinal bleeding resulting on people over 60 years old in Beijing

Risk factors associated with nonsteroidal anti-inflammatory drugs (NSAIDs)-induced gastrointestinal bleeding resulting on people over 60 years old in Beijing

Prescripciones de IBP a los pacientes de una oficina de farmacia, análisis de su ajuste a las recomendaciones y evidencias científicas publicadas

Rationalizing the use of PPIs: An unresolved matter

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