Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with NSAIDs, antiplatelet agents, and anticoagulants.
Am J Gastroenterol. 2007;102(3):507-15.
ABSTRACT
Methods: This case-control study matched 2,777 consecutive patients with UGIB (confirmed by endoscopy) with 5,532 controls (2:1). Adjusted relative risks (RR) of UGIB are reported.
Results: Proton pump inhibitors (PPIs) (RR: 0.33, 95% CI 0.27-0.39), H2-receptor antagonists (H2-RAs) (RR: 0.65, 95% CI 0.50-0.85), and nitrates (RR: 0.52, 95% CI 0.38-0.70) reduced UGIB risk. PPI use was associated with greater reductions among both traditional NSAID (RR: 0.13, 95% CI 0.09-0.19 vs. RR: 0.30, 95% CI 0.17-0.53 with H2-RAs; RR: 0.48, 95% CI 0.19-1.24 with nitrates) and low-dose aspirin users (RR: 0.32, 95% CI 0.22-0.51 vs. RR: 0.40, 95% CI 0.19-0.73 with H2-RA; RR: 0.69, 95% CI 0.36-1.04 with nitrates), and among patients taking clopidogrel (RR: 0.19, 95% CI 0.07-0.49). For patients taking anticoagulants, use of nitrates, H2-RA, or PPIs was not associated with a significant effect on UGIB risk.
Conclusion: Antisecretory agent or nitrate treatment is associated with reduced UGIB RR in patients taking NSAID or aspirin. Only PPI therapy was associated with a marked, consistent risk reduction among patients receiving all types of agents (including non-aspirin antiplatelet agents). Protection was not apparent in patients taking anticoagulants.
Objectives: After the withdrawal of some COX-2 selective inhibitors, traditional NSAID use has increased, but without additional prevention strategies against upper gastrointestinal complications in many cases. Here, we report the effect of antisecretory drugs and nitrates on the risk of upper gastrointestinal peptic ulcer bleeding (UGIB) associated with non-selective NSAIDs, aspirin, antiplatelet agents, and anticoagulants.