National mortality following upper gastrointestinal or cardiovascular events in older veterans with recent nonsteroidal anti‐inflammatory drug use

Abraham, Neena S.; Castillo, Diana; Hartman, Christine

doi:10.1111/j.1365-2036.2008.03706.x

Cited by 28 publications

(18 citation statements)

References 32 publications

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“…26 In fact, if deaths resulting from NSAID-associated upper GI complications were tabulated separately, it would represent the 15th most common cause of death in the United States. 29 National data from the Department of Veterans Affairs reveal that 43.0% of the veterans prescribed NSAIDs are considered to be at high risk for UGIE and that patients 65 years or older constitute the largest high-risk subset (87.1%).…”

Section: Mechanisms Of Gastroduodenal Injury-clopidogrelmentioning

confidence: 99%

ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use

Bhatt¹,

Scheiman²,

Abraham³

et al. 2008

Circulation

579

200

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Section: Mechanisms Of Gastroduodenal Injury-clopidogrelmentioning

confidence: 99%

ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use

Bhatt¹,

Scheiman²,

Abraham³

et al. 2008

Circulation

579

200

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“…This more realistically reflects the real-life experience and natural history of CAT exposure risk in a highly vulnerable, comorbid, elderly cardiovascular population. 24,25 NSAIDs such as low-dose ASA increase the risk of major bleeding ≈2-fold over placebo (relative risk, 1.71; 95% CI, 1.41-2.08) 26 and cause both UGIE and LGIE bleeding by direct injury to GI mucosa, causing ulceration and erosions, and via platelet thromboxane A2 production, which can exacerbate luminal bleeding from GI abnormalities, including vascular lesions, diverticulosis, and hemorrhoids.…”

Section: Discussionmentioning

confidence: 99%

Risk of Lower and Upper Gastrointestinal Bleeding, Transfusions, and Hospitalizations With Complex Antithrombotic Therapy in Elderly Patients

et al. 2013

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Background-Complex antithrombotic therapy (CAT) prescribed to elderly patients increases the risk of gastrointestinal bleeding. We quantified upper (UGIE) and lower gastrointestinal (LGIE) events, transfusions, and hospitalizations in a national cohort of elderly veterans prescribed CAT. Methods and Results-Veterans ≥60 years of age prescribed anticoagulant-antiplatelet, aspirin (ASA)-antiplatelet, ASAanticoagulant, or triple therapy (ie, TRIP, anticoagulant-antiplatelet-ASA) were identified from the national pharmacy database (October 1, 2002 to September 30, 2008. Prescription-fill data were linked to Veteran Affairs and Medicare encounter files, each person-day of follow-up was assessed for CAT exposure, and outcomes were defined by using diagnostic code algorithms derived following chart abstraction. Incidence density ratios (compared with the reference category of no CAT) and survival analysis was conducted. Among 78 133 veterans (98.6% white; mean age, 72.3 [standard deviation 7.7]), 64% were prescribed ASA-antiplatelet and anticoagulant-antiplatelet and 6% were prescribed TRIP. The incidence of UGIE was 20.1/1000 patient-years, and the incidence of LGIE was 70.1/1000 patient-years. ASA-anticoagulant and TRIP were associated with the highest incidence of transfusion and hospitalization. A 40% to 60% increased risk of UGIE was observed with all strategies.LGIE was 30% higher with anticoagulant-antiplatelet, and transfusion increased with ASA-anticoagulant (hazard ratio, 6.1; 95% confidence interval, 5.2-7.1) and TRIP (hazard ratio, 5.0; 95% confidence interval, 4.2-5.8). Increased risk of hospitalization was noted with all strategies. The number needed to harm for UGIE or LGIE ranged from 52 to 65 and 15 to 23, respectively. The number needed to harm for hospitalization was 39 (anticoagulant-antiplatelet), 34 (ASA-anticoagulant), 67 (ASA-antiplatelet), and 45 (TRIP) patients. Conclusions-Among

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“…Dyspepsia is the most common side effect, with serious complications including GI bleeding, ulceration, membranous rings, strictures, and colitis. One study demonstrated an increased absolute death rate of 5.5 per 100,000 person-years (95% CI, 5.4-5.6) after an upper GI event on comparison using incidence density ratio [1]. Mortality and morbidity of NSAID-induced GI injury continues to be high despite the availability of gastroprotective agents, with the cost of treating NSAID-induced ulcer complications estimated in billions of dollars annually [2].…”

Section: Introductionmentioning

confidence: 97%

NSAIDs and the gastrointestinal tract

Gupta¹,

Eisen

2009

Curr Gastroenterol Rep

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NSAIDs incur significant gastrointestinal (GI) side effects. The complication risk increases with history of peptic ulcer or older age. Helicobacter pylori infection and cardioprotective aspirin have independent and additive risks in the presence of NSAID use. NSAID enteropathy is increasingly recognized. Cardiovascular and GI risk stratification and H. pylori infection testing should be done before initiating NSAIDs. An NSAID combined with a proton pump inhibitor (PPI) is comparable to cyclooxygenase (COX)-2 inhibitors for gastroprotection, but for high-risk patients, COX-2 plus PPI should be considered. Aspirin and COX-2 inhibitors are associated with reduced colon adenoma risk, but higher dose and longer duration of treatment with aspirin appears effective. Hence, patients at high risk of colorectal cancer (with significant family or personal history of premalignant adenoma) must be identified, and cardiovascular and GI risk must be assessed before using these agents as chemopreventive drugs.

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National mortality following upper gastrointestinal or cardiovascular events in older veterans with recent nonsteroidal anti‐inflammatory drug use

Abstract: SUMMARY BackgroundUpper gastrointestinal events (UGIE), myocardial infarction (MI) and cerebrovascular accident (CVA) are known morbities among recent NSAID users.

Cited by 28 publications

References 32 publications

ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use

ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use

Risk of Lower and Upper Gastrointestinal Bleeding, Transfusions, and Hospitalizations With Complex Antithrombotic Therapy in Elderly Patients

NSAIDs and the gastrointestinal tract

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