The effects of nonsteroidal anti-inflammatory drugs on platelet function and severity of upper gastrointestinal haemorrhage

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) cause gastrointestinal (GI) damage primarily due to the inhibition of prostaglandin synthesis in gastric mucosa, which is an important factor in mucosa protection. Platelets are a cardinal feature of vascular repair. A variety of angiogenic stimulators are stored in platelets and are released during clotting at the wound. When there is a defect in any of these functions and/or platelet number, haemostasis is usually impaired and there may be an associated increased risk and severity of bleeding. While the mechanism of mucosal injury and bleeding are well documented with the use of NSAIDs, very little is known about the platelet function abnormalities and their effects on severity of upper GI bleedings. We performed a prospective analysis of 49 patients who had a history of NSAIDs use to investigate the association between the platelet function impairment associated with NSAIDs and severity of upper GI haemorrhages. Thirty-six of 49 patients (73.5%) had deteriorated platelet function. Mean severity score of patients with deteriorated platelet functions was 3.39, and that of patients with normal platelet functions was 2.46. Mean severity score was statistically significantly higher in patients with deteriorated platelet functions. In conclusion, impaired platelet functions associated with NSAIDs may cause more severe upper GI bleeding. Clinicians should be alert for GI complications especially in older patients and in those with a history of ulcer bleeding.

Platelet Function Analysis Using PFA-100 Tests in Patients With Acute Gastrointestinal Bleeding

“…These investigators found no difference in the admission hemoglobin, the source of bleed, the total number of RBC units transfused, ICU admission rate, or length of stay between the 2 groups. Consequently, antiplatelet drugs increased the overall risk score slightly in the study by Pasa et al 6 and increased the likelihood of transfusion in the study by Yong et al 8 In our study and the one by John et al, 9 antiplatelet drugs did not increase the transfusion requirements. Therefore, antiplatelet drugs appear to increase the frequency of GI bleeding in population studies but appear to have a minimal effect on the presentation or course in smaller clinical studies.…”

“…These changes in platelet function could contribute to the severity or outcomes in these patients, but this study did not provide information on outcomes. Pasa et al 6 evaluated patients with upper GI bleeds who were receiving nonsteroidal anti-inflammatory drugs. Seventy-five percent of these patients had decreased platelet function based on in vitro aggregation responses to various platelet agonists.…”

Slippery Platelet Syndromes in Subdural Hematoma

“…This observation does not exclude the possibility that NSAID use following a traumatic brain injury can be deleterious. In seniors with gastrointestinal bleeding and a history of NSAID use, 73% had abnormal PFA results and this subgroup had more severe bleeding compared to patients with normal PFA results [18,19].…”

Comparing Clinical Outcomes Following Percutaneous Vertebroplasty with Conservative Therapy for Acute Osteoporotic Vertebral Compression Fractures

“…Improvements of ODI scores were significantly greater in the PV group at 1 and 4 weeks, and patients in the PV group also used less medication. PV provides prompt pain relief, rapid improvements in physical functioning, and a decline in medication‐related complications [21].…”