Risk of Upper Gastrointestinal Bleeding From Different Drug Combinations

Masclee, Gwen; Valkhoff, Vera E.; Coloma, Preciosa M.; Ridder, Maria de; Romio, Silvana; Schuemie, Martijn J.; Herings, Ron M. C.; Gini, Rosa; Mazzaglia, Giampiero; Picelli, Gino; Scotti, Lorenza; Pedersen, Lars; Kuipers, Ernst J.; Lei, Johan van der; Sturkenboom, Miriam

doi:10.1053/j.gastro.2014.06.007

Cited by 139 publications

(117 citation statements)

References 43 publications

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“…In another study, six out of 1,206 patients treated with LDA alone and 21 out 1,208 patients treated with LDA plus warfarin had GI bleeding [70]. Masclee et al [71] recently published a case series analysis of data from 114,835 patients with upper GI bleeding. They showed that monotherapy with LDA increased the risk of diagnosis of upper GI bleeding (incidence rate ratio 3.1); the excess risk from concomitant use of LDA with anticoagulants was 1.9.…”

Section: Concomitant Use Of Anticoagulantsmentioning

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: Concomitant Use Of Anticoagulantsmentioning

confidence: 99%

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

Lanas

Gargallo²

2015

J Gastroenterol

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“…Relevant examples are the increased risk of bleeding in patients using anticoagulants, such as warfarin (Coumadin; Bristol-Myers Squibb, New York, NY) (Chan, 1995) or heparin, concurrently with NSAIDs, and the increase in phenytoin (Dilantin; Pfizer, New York, NY) blood level by NSAIDs, necessitating its monitoring when the NSAID dose is started or changed (Kaminski et al, 1998). A recent study further revealed the complex interactions between NSAIDs and several commonly used drugs, such as corticosteroids, aldosterone antagonists, and selective serotonin reuptake inhibitors, in enhancing the risk of upper GI bleeding when used in combination (Masclee et al, 2014). Underscoring the notion of cumulative toxicity, taking a second NSAID at the same time clearly increases the risk of side effects.…”

Section: Introductionmentioning

confidence: 99%

The Evolving Role of Nonsteroidal Anti-Inflammatory Drugs in Colon Cancer Prevention: A Cause for Optimism

Rigas

Tsioulias

2015

J Pharmacol Exp Ther

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Colorectal cancer (CRC) is a serious yet preventable disease. The low acceptance and cost of colonoscopy as a screening method for CRC make chemoprevention an important option. Nonsteroidal anti-inflammatory drugs (NSAIDs), not currently recommended for CRC prevention, have the potential to evolve into the agents of choice for this indication. Here, we discuss the promise and challenge of NSAIDs for this chemopreventive application. Multiple epidemiologic studies, randomized clinical trials (RCTs) of sporadic colorectal polyp recurrence, RCTs in patients with hereditary colorectal cancer syndromes, and pooled analyses of cardiovascular-prevention RCTs linked to cancer outcomes have firmly established the ability of conventional NSAIDs to prevent CRC. NSAIDs, however, are seriously limited by their toxicity, which can become cumulative with their long-term administration for chemoprevention, whereas drug interactions in vulnerable elderly patients compound their safety. Newer, chemically modified NSAIDs offer the hope of enhanced efficacy and safety. Recent work also indicates that targeting earlier stages of colorectal carcinogenesis, such as the lower complexity aberrant crypt foci, is a promising approach that may only require relatively short use of chemopreventive agents. Drug combination approaches exemplified by sulindac plus difluoromethylornithine appear very efficacious. Identification of those at risk or most likely to benefit from a given intervention using predictive biomarkers may usher in personalized chemoprevention. Agents that offer simultaneous chemoprevention of diseases in addition to CRC, e.g., cardiovascular and/or neurodegenerative diseases, may have a much greater potential for a broad clinical application.

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“…Other factors, such as concomitant usage of antiplatelet agents [15,23,24], anti-coagulants [25][26][27] and steroids [16,28,29] have been shown to increase the risk of NSAID-associated GI complications but these factors were not found to be predictive in this study. We were not able to explore the role of Helicobacter pylori infection [17,30] or higher doses of NSAIDs [2,31] and multiple NSAID use [28], which are recognised causes of NSAID-associated GI complications as this information was not available for all patients in this study.…”

Section: Predictive Factors Of Upper Gi Adverse Eventsmentioning

confidence: 59%

Risk of upper gastrointestinal adverse events in Malaysian rheumatic patients on long-term non-steroidal antiinflammatory drugs

Pok¹,

Shabaruddin²,

Dahlui³

et al. 2018

Int. J. Clin. Rheumatol

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Risk of Upper Gastrointestinal Bleeding From Different Drug Combinations

Cited by 139 publications

References 43 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

The Evolving Role of Nonsteroidal Anti-Inflammatory Drugs in Colon Cancer Prevention: A Cause for Optimism

Risk of upper gastrointestinal adverse events in Malaysian rheumatic patients on long-term non-steroidal antiinflammatory drugs

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