Nonsteroidal Anti-Inflammatory Drugs and Risk of Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

Area of Science:

• Pharmacology
• Gastroenterology
• Clinical Research

Background:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for pain and inflammation.
• NSAID use is associated with an increased risk of gastrointestinal (GI) bleeding.
• Current research often treats NSAIDs as a single class, limiting individualized risk assessment.

Purpose of the Study:

• To systematically review and meta-analyze the risk of GI bleeding associated with individual NSAIDs.
• To quantify the comparative risk of GI bleeding for commonly used NSAIDs.
• To inform clinical decision-making regarding NSAID selection based on bleeding risk.

Main Methods:

• A systematic literature search was conducted in PubMed for studies on GI bleeding and nine common NSAIDs.
• A random effects meta-analysis was performed to calculate pooled odds ratios (ORs) for GI bleeding.
• Hazard ratios (HRs) and relative risks (RRs) were used as approximations for ORs given the rarity of GI bleeding events.

Main Results:

• Twenty-five studies met the inclusion criteria from 6,711 screened records.
• Significant heterogeneity was observed across study designs, populations, and outcome assessments.
• Celecoxib demonstrated the lowest GI bleeding risk (OR 1.16). Among non-selective NSAIDs, ibuprofen had the lowest significant risk (OR 2.28), and ketorolac exhibited the highest risk (OR 20.67).

Conclusions:

• The risk of GI bleeding substantially differs among individual NSAIDs.
• Celecoxib appears to be associated with the lowest GI bleeding risk, although cardiovascular safety requires consideration.
• NSAIDs should not be uniformly classified when assessing bleeding risk; personalized selection is recommended.