Nonsteroidal antiinflammatory drugs and upper gastrointestinal hemorrhage in an urban hospital

Abstract

Aspirin and nonsteroidal antiinflammatory drugs have been implicated in the pathogenesis of gastrointestinal hemorrhage. To evaluate their impact on inpatients, charts from Temple University Hospital with a discharge ICD-9 code which included upper gastrointestinal hemorrhage during a one-year period were reviewed. Aspirin and/or nonaspirin nonsteroid antiinflammatory drug (NSAID) use was identified in 34 patients (19 daily users and 15 intermittent users). Sixty-seven patients who bled, but did not use these agents, served as controls. Daily NSAID users were older than intermittent users and controls (P < 0.05). A higher frequency of bleeding ulcers was associated with NSAID use. Patients using NSAIDs spent more time in intensive care than controls (median 1 day vs 0 days). Daily users had a higher transfusion requirement (4 units) than non-users (0 units; P < 0.05). This study suggests that NSAID use has a substantial impact on health care resource utilization in patients admitted to an urban hospital for upper gastrointestinal hemorrhage.

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

“…Numerous case series describe mortality among patients admitted to hospital with a serious GI bleed (23, 24, 26–29, 31–33). Only 3 distinguish first‐time bleeders from recurrent bleeders (27, 32, 33).…”

“…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).…”

Potential drug–drug interactions among prescriptionsfor elderly patients in primary health care

“…A well-known D risk rating category DDI is between acetylsalicylic acid and nonsteroid anti-inflammatory drugs (NSAIDs) or vitamin K antagonists such as warfarin. Toxicity in the upper gastrointestinal tract is a serious effect of NSAIDs (22) and concomitant use of salicylates and NSAIDs or anticoagulants can increase the risk of gastrointestinal bleeding (23,24). Moreover, combination therapies of NSAIDs and steroids or antidepressants can lead to unwanted bleeding reactions (22,25).…”