The association of nonsteroidal anti-inflammatory drugs with upper gastrointestinal tract bleeding

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Published on: September 20, 2018

J L Carson, B L Strom, K A Soper

    Archives of Internal Medicine
    |January 1, 1987
    PubMed

    Insights

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are linked to upper gastrointestinal (UGI) bleeding. While the risk is small, this study confirms a significant association, especially with longer NSAID use.

    Area of Science:

    • Pharmacovigilance
    • Gastroenterology
    • Epidemiology

    Background:

    • Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for pain and inflammation.
    • Upper gastrointestinal (UGI) bleeding is a known potential adverse effect of NSAID use.
    • Quantifying the precise risk associated with NSAIDs is crucial for patient safety.

    Purpose of the Study:

    • To evaluate the risk of developing upper gastrointestinal (UGI) bleeding associated with nonsteroidal anti-inflammatory drug (NSAID) use.
    • To determine the relationship between NSAID exposure and UGI bleeding events.

    Main Methods:

    • Retrospective cohort study utilizing 1980 Medicaid billing data from Michigan and Minnesota.
    • Comparison of 47,136 NSAID-exposed patients with 44,634 unexposed patients.
    • Logistic regression analysis to adjust for confounding variables such as age, sex, alcohol use, and pre-existing conditions.

    Main Results:

    • The unadjusted relative risk for UGI bleeding within 30 days of NSAID exposure was 1.5 (95% CI: 1.2-2.0).
    • Associations were observed between UGI bleeding and age, sex, state, alcohol diagnoses, abdominal conditions, and anticoagulant use.
    • The NSAID-associated risk of UGI bleeding remained significant after adjusting for confounding factors, showing linear dose-response and quadratic duration-response relationships.

    Conclusions:

    • Nonsteroidal anti-inflammatory drugs are significantly associated with an increased risk of upper gastrointestinal bleeding.
    • The magnitude of the increased risk is relatively small, offering some reassurance.
    • The study highlights the importance of considering NSAID use in patients presenting with UGI bleeding.

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