Anti-inflammatory drugs and variceal bleeding: a case-control study

Area of Science:

• Gastroenterology
• Hepatology
• Clinical Pharmacology

Background:

• Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with severe gastrointestinal complications, including peptic ulcer bleeding.
• Acute bleeding from oesophageal varices is a critical and life-threatening complication in patients with cirrhosis of the liver.

Purpose of the Study:

• To investigate the association between non-steroidal anti-inflammatory drug (NSAID) use and the occurrence of first-time bleeding episodes in cirrhotic patients with oesophageal or cardial varices.
• To identify risk factors for variceal bleeding in patients with cirrhosis.

Main Methods:

• A case-control study was conducted involving 125 cirrhotic patients who experienced bleeding related to oesophageal varices (cases) and 75 cirrhotic patients with oesophageal varices who had no prior bleeding history (controls).
• Data on NSAID use, including aspirin, were collected via structured interviews.

Main Results:

• Patients admitted for variceal bleeding were significantly more likely to have used NSAIDs in the week preceding the event (25%) compared to controls (11%), with an odds ratio of 2.8 (p=0.016).
• Aspirin use, alone or with other NSAIDs, was more prevalent in cases (17%) than controls (4%), yielding an odds ratio of 4.9 (p=0.007).
• Logistic regression identified NSAID use (OR=2.9) and variceal size (OR=4.0) as independent predictors of variceal bleeding risk.

Conclusions:

• Aspirin, whether used alone or in combination with other NSAIDs, is associated with an increased risk of first-time variceal bleeding in patients with cirrhosis.
• The potential benefits of aspirin therapy in cirrhotic patients must be carefully weighed against the demonstrated risk of variceal bleeding.
• No definitive conclusions could be drawn regarding the independent risk associated with non-aspirin NSAIDs.