The Risk of Acute Major Upper Gastrointestinal Bleeding Among Users of Aspirin and Ibuprofen at Various Levels of Alcohol Consumption

Kaufman, David W.; Kelly, Judith P.; Wiholm, Bengt‐Erik; László, András; Sheehan, Jane; Koff, Raymond S.; Shapiro, Samuel

doi:10.1111/j.1572-0241.1999.01517.x

Cited by 97 publications

(22 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…After review of the abstracted information, 28 studies on the use of individual NSAIDs and the risk of UGIC met the inclusion criteria and were included in the meta-analysis. [7,11–35] The remaining 31 articles were excluded for the following reasons: the reference group was other than non-use of NSAIDs in nine studies;[36–44] the outcome was overall upper and lower GI complications in three studies;[45–47] the outcome was uncomplicated upper GI events in two studies;[48,49] the study population was restricted to users of specific drugs or to patients with specific diseases in three studies;[50–52] the study population and the study period overlapped in four studies;[53–56] and the study design did not meet the inclusion criteria in ten studies (i.e. different type of study or measures of association and exposure assessment).…”

Section: Resultsmentioning

confidence: 99%

Individual NSAIDs and Upper Gastrointestinal Complications

et al. 2012

View full text Add to dashboard Cite

Background: The risk of upper gastrointestinal (GI) complications associated with the use of NSAIDs is a serious public health concern. The risk varies between individual NSAIDs; however, there is little information on the risk associated with some NSAIDs and on the impact of risk factors. These data are necessary to evaluate the benefit-risk of individual NSAIDs for clinical and health policy decision making. Within the European Community’s Seventh Framework Programme, the Safety Of non-Steroidal anti-inflammatory drugs (NSAIDs) [SOS] project aims to develop decision models for regulatory and clinical use of individual NSAIDs according to their GI and cardiovascular safety.Objective: The aim of this study was to conduct a systematic review and meta-analysis of observational studies to provide summary relative risks (RR) of upper GI complications (UGIC) associated with the use of individual NSAIDs, including selective cyclooxygenase-2 inhibitors.Methods: We used the MEDLINE database to identify cohort and case-control studies published between 1 January 1980 and 31 May 2011, providing adjusted effect estimates for UGIC comparing individual NSAIDs with non-use of NSAIDs. We estimated pooled RR and 95% CIs of UGIC for individual NSAIDs overall and by dose using fixed- and random-effects methods. Subgroup analyses were conducted to evaluate methodological and clinical heterogeneity between studies.Results: A total of 2984 articles were identified and 59 were selected for data abstraction. After review of the abstracted information, 28 studies met the meta-analysis inclusion criteria. Pooled RR ranged from 1.43 (95% CI 0.65, 3.15) for aceclofenac to 18.45 (95% CI 10.99, 30.97) for azapropazone. RR was less than 2 for aceclofenac, celecoxib (RR 1.45; 95% CI 1.17, 1.81) and ibuprofen (RR 1.84; 95% CI 1.54, 2.20); 2 to less than 4 for rofecoxib (RR 2.32; 95% CI 1.89, 2.86), sulindac (RR 2.89; 95% CI 1.90, 4.42), diclofenac (RR 3.34; 95% CI 2.79, 3.99), meloxicam (RR 3.47; 95% CI 2.19, 5.50), nimesulide (RR 3.83; 95% CI 3.20, 4.60) and ketoprofen (RR 3.92; 95% CI 2.70, 5.69); 4–5 for tenoxicam (RR 4.10; 95% CI 2.16, 7.79), naproxen (RR 4.10; 95% CI 3.22, 5.23), indometacin (RR 4.14; 95% CI 2.91, 5.90) and diflunisal (RR 4.37; 95% CI 1.07, 17.81); and greater than 5 for piroxicam (RR 7.43; 95% CI 5.19, 10.63), ketorolac (RR 11.50; 95% CI 5.56, 23.78) and azapropazone. RRs for the use of high daily doses of NSAIDs versus non-use were 2-3 times higher than those associated with low daily doses.Conclusions: We confirmed variability in the risk of UGIC among individual NSAIDs as used in clinical practice. Factors influencing findings across studies (e.g. definition and validation of UGIC, exposure assessment, analysis of new vs prevalent users) and the scarce data on the effect of dose and duration of use of NSAIDs and on concurrent use of other medications need to be addressed in future studies, including SOS.

show abstract

Section: Resultsmentioning

confidence: 99%

Individual NSAIDs and Upper Gastrointestinal Complications

et al. 2012

View full text Add to dashboard Cite

show abstract

“…unclear interpretation of discordant pairs for McNemar's test) [36]. From the 22 published epidemiologic studies ful®lling all the inclusion criteria, one reported the same results in a different language [37,38], three reported results from the same study population as more recently published articles [39±41], and one presented additional analyses from a sample that overlapped with a previous article [42]. Hence, the ®nal number of analysed studies was 17 [38, 43±58].…”

Section: Methodsmentioning

confidence: 99%

Association between aspirin and upper gastrointestinal complications: Systematic review of epidemiologic studies

Rodrı́guez

Hernández–Dı́az

Abajo³

2001

Brit J Clinical Pharma

248

View full text Add to dashboard Cite

Aims Because of the widespread use of aspirin for prevention of cardiovascular diseases, side-effects associated with thromboprophylactic doses are of interest. This study summarizes the relative risk (RR) for serious upper gastrointestinal complications (UGIC) associated with aspirin exposure in general and with speci®c aspirin doses and formulations in particular.Methods After a systematic review, 17 original epidemiologic studies published between 1990 and 2001 were selected according to prede®ned criteria. Heterogeneity of effects was explored. Pooled estimates were calculated according to different study characteristics and patterns of aspirin use. Results The overall relative risk of UGIC associated with aspirin use was 2.2 (95% con®dence interval (CI): 2.1, 2.4) for cohort studies and nested case-control studies and 3.1 (95% CI: 2.8, 3.3) for non-nested case-control studies. Original studies found a dose±response relationship between UGIC and aspirin, although the risk was still elevated for doses lower or up to 300 mg day x1 . The summary RR was 2.6 (95% CI: 2.3, 2.9) for plain, 5.3 (95% CI: 3.0, 9.2) for buffered, and 2.4 (95% CI: 1.9, 2.9) for enteric-coated aspirin formulations. Conclusions Aspirin was associated with UGIC even when used at low doses or in buffered or enteric-coated formulations. The latter ®ndings may be partially explained by channeling of susceptible patients to these formulations.

show abstract

“…58 Aspirin and other nonsteroidal antiinflammatory drugs, when combined with alcohol, can raise the risk of gastrointestinal bleeding by injuring the gastric mucosa and increasing the bleeding tendency 58 ; however, aspirin and alcohol appeared to act as independent risk factors, with additive effects on gastrointestinal bleeding but no interaction. 60 Experimental data 61 suggest that wine polyphenols might interact with aspirin, because they form stable complexes in the platelet cyclooxygenase-1 enzyme channel. Mixtures of resveratrol, quercetin, and gallic acid did potentiate the platelet inhibitory effect of subinhibitory concentrations of aspirin.…”

Section: Costanzo Et Al Alcohol and Mortality In Cvd Patientsmentioning

confidence: 99%