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Risk Factors for Upper Gastrointestinal Bleeding in Patients Taking Selective COX-2 Inhibitors: A Nationwide
Xi-Hsuan Lin1,2, Shih-Hao Young1,2, Jiing-Chyuan Luo1,2,3
1Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Taiwan.
Insights
Cyclooxygenase-2 inhibitors (coxibs) increase upper gastrointestinal bleeding (UGIB) risk. Key risk factors for UGIB in coxibs users include H. pylori infection and prior peptic ulcer bleeding.
Area of Science:
- Gastroenterology
- Pharmacology
- Epidemiology
Background:
- Cyclooxygenase-2 inhibitors (coxibs) offer an alternative to traditional nonsteroidal anti-inflammatory drugs (tNSAIDs) with potentially fewer upper gastrointestinal bleeding (UGIB) risks.
- However, coxibs may still elevate UGIB risk, particularly in high-risk patient populations.
Purpose of the Study:
- To identify specific risk factors associated with upper gastrointestinal bleeding (UGIB) among patients using cyclooxygenase-2 inhibitors (coxibs).
Main Methods:
- A retrospective cohort study utilizing the 2000-2010 National Health Insurance Research Database of Taiwan.
- Propensity score matching was employed to create comparable groups of 12,145 coxibs users and 12,145 controls.
- Cox multivariate proportional hazard regression models were used to analyze UGIB risk factors.
Main Results:
- Coxibs users exhibited a significantly higher incidence of UGIB compared to matched controls (P < 0.001).
- Coxibs use was associated with an increased risk of UGIB (Hazard Ratio = 1.37; 95% CI = 1.19-1.55).
- Independent risk factors for UGIB in coxibs users included age, male gender, diabetes, chronic renal disease, cirrhosis, history of peptic ulcer disease, peptic ulcer bleeding (PUB), Helicobacter pylori (H. pylori) infection, and concurrent use of tNSAIDs, acetylsalicylic acid, or thienopyridines.
Conclusions:
- Helicobacter pylori infection and a history of peptic ulcer bleeding (PUB) were identified as particularly significant risk factors for UGIB in coxibs users.
- Further research is warranted to investigate the potential protective role of proton pump inhibitors in high-risk coxibs users.
Objective:
Cyclooxygenase-2 inhibitors (coxibs) are associated with less upper gastrointestinal bleeding (UGIB) than traditional nonsteroidal anti-inflammatory drugs (tNSAIDs). However, they also increase the risk of UGIB in high-risk patients. We aimed to identify the risk factors of UGIB in coxibs users.
Design:
Retrospective cohort study.
Setting:
2000-2010 National Health Insurance Research Database of Taiwan.
Subjects:
Patients taking coxibs as the study group and patients not taking any coxibs as controls.
Methods:
After age, gender, and comorbidity matching by propensity score, 12,145 coxibs users and 12,145 matched controls were extracted for analysis. The primary end point was the occurrence of UGIB. Cox multivariate proportional hazard regression models were used to determine the risk factors for UGIB among all the enrollees and coxibs users.
Results:
During a mean follow-up of three years, coxibs users had significantly higher incidence of UGIB than matched controls (P < 0.001, log-rank test). Cox regression analysis showed that coxibs increased risk of UGIB in all participants (hazard ratio = 1.37, 95% confidence interval = 1.19-1.55, P < 0.001). Independent risk factors for UGIB among coxibs users were age, male gender, diabetes, chronic renal disease, cirrhosis, history of peptic ulcer disease, PU bleeding (PUB), Helicobacter pylori (H. pylori) infection, and concomitant use of tNSAIDs, acetylsalicylic acid, or thienopyridines.
Conclusions:
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.
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