Risk Factors for Upper Gastrointestinal Bleeding in Patients Taking Selective COX-2 Inhibitors: A Nationwide Population-Based Cohort Study

Lin, Xi-Hsuan; Young, Shih‐Hao; Luo, Jiing‐Chyuan; Peng, Yuting; Chen, Ping‐Hsien; Lin, Chung‐Chi; Chen, Wei-Ming; Hou, Ming‐Chih; Lee, Fa-Yauh

doi:10.1093/pm/pnx097

Cited by 11 publications

(7 citation statements)

References 29 publications

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“…Lin et al [ 14 ] reported that cyclooxygenase-2 selective inhibitors (coxibs) significantly increased the incidence of UGIB, and various risk factors, including age, male gender, history of uncomplicated peptic ulcer disease, peptic ulcer bleeding, and H. pylori infection, contributed to the development of UGIB in coxibs users. The use of non-steroidal anti-inflammatory agents (NSAIDs) and anticoagulation agents associated with aging was considered to increase the development of UGIB by peptic ulcer.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of scoring systems without endoscopic findings for predicting outcomes in patients with upper gastrointestinal bleeding

Kim

Chang

et al. 2017

BMC Gastroenterol

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BackgroundRisk scoring systems are used to evaluate patients with upper gastrointestinal bleeding (UGIB). We compared Glasgow-Blatchford score (GBS), modified GBS (mGBS), and Pre-endoscopy Rockall score (Pre-E RS) for immediate application without endoscopic findings in predicting the need of interventions and the 30-day mortality in patients with UGIB.MethodsPatients who visited the emergency room with UGIB from January 2007 to June 2016 were included. GBS, mGBS, and Pre-E RS were obtained for all patients. The area under the receiver-operating characteristic curves (AUC) was used to assess the accuracy of the scoring systems to determine the need for interventions and 30-day mortality. Also, we investigated the potential cutoff scores for predicting 30-day mortality and the need for interventions.ResultsIn predicting the need for interventions, GBS (AUC = 0.727) and mGBS (AUC = 0.733) outperformed Pre-E RS (AUC = 0.564, P < 0.0001). In predicting 30-day mortality, Pre-E RS (AUC = 0.929) outperformed GBS (AUC = 0.664, P < 0.0001) and mGBS (AUC = 0.652, P < 0.0001). Based on AUC analyses of sensitivities and specificities, the optimal cutoff mGBS and GBS for the need for interventions was 9 (70.71% sensitivity, 89.35% specificity) and 9 (73.57% sensitivity, 82.90% specificity) respectively, and optimal cutoff Pre-E RS for 30-day mortality was 4 (88.0% sensitivity, 97.52% specificity).ConclusionsGBS and mGBS are considered to be moderately accurate in making an early decision about the need of interventions in patients with UGIB. Pre-E RS is considered to be highly accurate in early detection of patients at high risk for 30-day mortality without endoscopic findings. In addition, we suggested potential cutoff scores to predict the need of interventions for GBS and mGBS, and 30-day mortality for Pre-E RS. Further studies are needed to confirm the clinical applicability of results.

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Section: Discussionmentioning

confidence: 99%

Evaluation of scoring systems without endoscopic findings for predicting outcomes in patients with upper gastrointestinal bleeding

Kim

Chang

et al. 2017

BMC Gastroenterol

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“…Independent risk factors for bleeding among coxib users were age, male gender, diabetes, chronic renal disease, cirrhosis, history of PUD, H. pylori infection, and concomitant use of NSAIDs, aspirin, or thienopyridines. H. pylori infection and history of PU bleeding were important risk factors for rebleeding …”

Section: Helicobacter Pylori and Peptic Ulcer Diseasementioning

confidence: 99%

“…pylori infection and history of PU bleeding were important risk factors for rebleeding. 10 In a case-control study, Swiss investigators assessed the role of glucocorticoid consumption in the development of bleeding PUD.…”

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confidence: 99%

Helicobacter pylori and nonmalignant upper gastrointestinal diseases

2018

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The review of the most important recent publications concerning the relation of Helicobacter pylori with peptic ulcer disease (PUD), noninvestigated and functional dyspepsia, and gastroesophageal reflux disease (GERD) is presented. H. pylori remains the main etiopathogenetic factor in complicated and uncomplicated PUD. Nevertheless, the role of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin is increasing. The novel data did not confirm that PUD caused by NSAIDs and aspirin is less symptomatic. The role of glucocorticoids, immunosuppressants, and antidepressants seems to be of some importance. Although the involvement of H. pylori in functional dyspepsia is controversial, several data support the importance of H. pylori-induced gastritis in the pathogenesis of dyspeptic symptoms. Recent interventional studies have reported that H. pylori eradication improves dyspepsia mainly in areas with a high prevalence of this bacterium. Novel data regarding the relation of gastrointestinal peptides, ghrelin and obestatin, with H. pylori infection are also presented. Intriguing findings support the involvement of the gastric microbiota in the causation of chronic functional dyspepsia. Finally, some data concerning negative, positive, or neutral associations of H. pylori with gastroesophageal reflux disease (GERD) were published. In this context, today there is no evidence indicating that H. pylori eradication could worsen the symptoms or the course of GERD.

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“…29 Furthermore, in a nationwide cohort study, it was demonstrated that patients taking COX-2 selective inhibitors have an increased risk of upper GI bleeding especially if they had history of uncomplicated peptic ulcer or Helicobacter pylori infection. 30 Our analysis found that patients receiving the combination of warfarin and selective COX-2 inhibitors experience an almost twofold increase risk in GI bleeding, similar to traditional NSAIDs. For those studies evaluating bleeding from any source, no significant increase was observed.…”

Section: Discussionmentioning

confidence: 68%

Risk of Bleeding with Exposure to Warfarin and Nonsteroidal Anti-Inflammatory Drugs: A Systematic Review and Meta-Analysis

et al. 2020

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Abstract Background Warfarin use can trigger the occurrence of bleeding independently or as a result of a drug–drug interaction when used in combination with nonsteroidal anti-inflammatory drugs (NSAIDs). Objectives This article examines the risk of bleeding in individuals exposed to concomitant warfarin and NSAID compared with those taking warfarin alone (Prospero Registry ID 145237). Methods PubMed, EMBASE, Scopus, and Web of Science were searched. The primary outcome of interest was gastrointestinal bleeding and general bleeding. Summary effects were calculated to estimate average treatment effect using random effects models. Heterogeneity was assessed using Cochran's Q and I 2. Risk of bias was also assessed using the Agency for Healthcare Research and Quality bias assessment tool. Results A total of 651 studies were identified, of which 11 studies met inclusion criteria for meta-analysis. The odds ratio (OR) for gastrointestinal bleeding when exposed to warfarin and an NSAID was 1.98 (95% confidence interval [CI]: 1.55–2.53). The risk of gastrointestinal bleeding was also significantly elevated with exposure to a COX-2 inhibitor and warfarin relative to warfarin alone (OR = 1.90, 95% CI: 1.46–2.46). There was an increased risk of general bleeding with the combination of warfarin with NSAIDs (OR = 1.58, 95% CI: 1.18–2.12) or COX-2 inhibitors (OR = 1.54, 95% CI: 0.86–2.78) compared with warfarin alone. Conclusion Risk of bleeding is significantly increased among persons taking warfarin and a NSAID or COX-2 inhibitor together as compared with taking warfarin alone. It is important to caution patients about taking these medications in combination.

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Risk Factors for Upper Gastrointestinal Bleeding in Patients Taking Selective COX-2 Inhibitors: A Nationwide Population-Based Cohort Study

Abstract: Among coxibs users, H. pylori infection and history of PUB were especially important risk factors for UGIB. Further studies are needed to determine whether proton pump inhibitors might play a protective role in these at-risk patients.

Cited by 11 publications

References 29 publications

Evaluation of scoring systems without endoscopic findings for predicting outcomes in patients with upper gastrointestinal bleeding

Evaluation of scoring systems without endoscopic findings for predicting outcomes in patients with upper gastrointestinal bleeding

Helicobacter pylori and nonmalignant upper gastrointestinal diseases

Risk of Bleeding with Exposure to Warfarin and Nonsteroidal Anti-Inflammatory Drugs: A Systematic Review and Meta-Analysis

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