Faecal blood loss with aspirin, nonsteroidal anti-inflammatory drugs and cyclo-oxygenase-2 selective inhibitors: systematic review of randomized trials using autologous chromium-labelled erythrocytes

Moore, R Andrew; Derry, Sheena; McQuay, Henry J

doi:10.1186/ar2355

Cited by 46 publications

(26 citation statements)

References 52 publications

(45 reference statements)

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“…This amount increases up to 10 ml/day in some patients who take highdose aspirin ([325 mg/day) [24]. One study in healthy volunteers showed that even enteric-coated LDA was associated with asymptomatic damage in 50 % of volunteers, and a few of them developed ulcers in their small bowel [25].…”

Section: Effects Of Low-dose Aspirin In the Gastrointestinal Tractmentioning

confidence: 99%

Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

Lanas

Gargallo²

2015

J Gastroenterol

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Low-dose aspirin, alone or combined with other antiplatelet agents, is increasingly prescribed for cardiovascular prevention. However, the cardiovascular benefits should be evaluated together with the gastrointestinal risks. Low-dose aspirin is associated with upper and lower gastrointestinal injury, although lower gastrointestinal effects are poorly characterized. This gastrointestinal risk differs among antiplatelets drugs users. The most important risk factors are history of peptic ulcer, older age, and concomitant use of non-steroidal anti-inflammatory drugs or dual antiplatelet therapy. Effective upper gastrointestinal prevention strategies are available and should be used in at-risk patients taking low-dose aspirin or clopidogrel. Proton pump inhibitors seem to be the best gastroprotective agents, whereas the benefits of Helicobacter pylori eradication are still unclear. Low-dose aspirin has additional effects in the gastrointestinal tract. A large body of evidence indicates that it can protect against different cancers, in particular colorectal cancer. This effect could modify the future indications for use of low-dose aspirin and the risk-benefit balance.

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Section: Effects Of Low-dose Aspirin In the Gastrointestinal Tractmentioning

confidence: 99%

Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

Lanas

Gargallo²

2015

J Gastroenterol

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“…In addition, by directly controlling the risk while maximizing the efficacy, there is no need to examine the trade-off between the benefit and risk to form a composite outcome or utility function, as done in the benefit-risk analysis (Guo et al, 2010) or as required in some existing work (e.g., Houede et al, 2010). How to weight benefit and risk in a manner that addresses the complexity of the clinical contexts in which a medical decision is made is a separate issue that deserves attention in its own right (Moore et al, 2008). In our approach, the problem of how to compare dissimilar outcomes is avoided.…”

Section: Introductionmentioning

confidence: 99%

Learning Optimal Personalized Treatment Rules in Consideration of Benefit and Risk: With an Application to Treating Type 2 Diabetes Patients With Insulin Therapies

Wang

Zeng

2018

Journal of the American Statistical Association

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Individualized medical decision making is often complex due to patient treatment response heterogeneity. Pharmacotherapy may exhibit distinct efficacy and safety profiles for different patient populations. An “optimal” treatment that maximizes clinical benefit for a patient may also lead to concern of safety due to a high risk of adverse events. Thus, to guide individualized clinical decision making and deliver optimal tailored treatments, maximizing clinical benefit should be considered in the context of controlling for potential risk. In this work, we propose two approaches to identify personalized optimal treatment strategy that maximizes clinical benefit under a constraint on the average risk. We derive the theoretical optimal treatment rule under the risk constraint and draw an analogy to the Neyman-Pearson lemma to prove the theorem. We present algorithms that can be easily implemented by any off-the-shelf quadratic programming package. We conduct extensive simulation studies to show satisfactory risk control when maximizing the clinical benefit. Lastly, we apply our method to a randomized trial of type 2 diabetes patients to guide optimal utilization of the first line insulin treatments based on individual patient characteristics while controlling for the rate of hypoglycemia events. We identify baseline glycated hemoglobin level, body mass index, and fasting blood glucose as three key factors among 18 biomarkers to differentiate treatment assignments, and demonstrate a successful control of the risk of hypoglycemia in both the training and testing data set.

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“…Although the use of a risk scale to convey outcome information has been proposed, (4, 32–35) its usefulness for this purpose has not been thoroughly evaluated. To our knowledge, this is the first study to compare the effectiveness of risk scales in communicating comparative effectiveness information with that of other commonly used data presentation formats.…”

Section: Discussionmentioning

confidence: 99%

How Well Do Commonly Used Data Presentation Formats Support Comparative Effectiveness Evaluations?

Qian

2012

Med Decis Making

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Background Good decisions depend on an accurate understanding of the comparative effectiveness of decision alternatives. The best way convey data needed to support these comparisons is unknown. Objective To determine how well five commonly used data presentation formats convey comparative effectiveness information. Design Internet survey using a factorial design. Subjects 279 members of an online survey panel. Intervention Study participants compared outcomes associated with three hypothetical screening test options relative to five possible outcomes with probabilities ranging from 2 per 5,000 (0.04%) to 500 per 1,000 (50%). Data presentation formats included a table, a “magnified” bar chart, a risk scale, a frequency diagram, and an icon array. Measurements Outcomes included the number of correct ordinal judgments regarding the more likely of two outcomes, the ratio of perceived versus actual relative likelihoods of the paired outcomes, the inter-subject consistency of responses, and perceived clarity. Results The mean number of correct ordinal judgments was 12 of 15 (80%), with no differences among data formats. On average, there was a 3.3-fold difference between perceived and actual likelihood ratios,95%CI: 3.0 to 3.6. Comparative judgments based on flow charts, icon arrays, and tables were all significantly more accurate and consistent than those based on risk scales and bar charts, p < 0.001. The most clearly perceived formats were the table and the flow chart. Low subjective numeracy was associated with less accurate and more variable data interpretations and lower perceived clarity for icon displays, bar charts, and flow diagrams. Conclusions None of the data presentation formats studied can reliably provide patients, especially those with low subjective numeracy, with an accurate understanding of comparative effectiveness information.

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Faecal blood loss with aspirin, nonsteroidal anti-inflammatory drugs and cyclo-oxygenase-2 selective inhibitors: systematic review of randomized trials using autologous chromium-labelled erythrocytes

Cited by 46 publications

References 52 publications

Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

Learning Optimal Personalized Treatment Rules in Consideration of Benefit and Risk: With an Application to Treating Type 2 Diabetes Patients With Insulin Therapies

How Well Do Commonly Used Data Presentation Formats Support Comparative Effectiveness Evaluations?

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