A model to predict the risk of aspirin/non‐steroidal anti‐inflammatory drugs‐related upper gastrointestinal bleeding for the individual patient

Abstract

Upper gastrointestinal bleeding is a feared complication of using non‐steroidal anti‐inflammatory drugs (NSAIDs) or aspirin. Studies predicting the incidence rate for individuals with a given set of characteristics are lacking. The aim of this study was to develop a risk model to predict the incidence rate of upper gastrointestinal bleeding (UGIB) in users of aspirin/NSAID based on presence of well‐defined risk factors for the individual patient. Methods The model was developed from data from a case‐control study, sampled from a well‐defined source population, residents of the Funen County 1995‐2006. All cases and controls were characterized in terms of factors known to affect the risk of UGIB. By using census data, we rescaled the control group, so their composition accurately reflected age and sex distribution of the source population. Only persons using NSAIDs or/and aspirin and no PPI were included in the analysis. As reference group, we chose 80‐ to 89‐year‐old women with no ulcer history, using NSAID, but neither aspirin, other platelet inhibitors, vitamin K antagonists, selective serotonin reuptake inhibitors nor corticosteroids. Results We identified 1388 cases among non‐users of PPIs. We found a modelled baseline incidence rate of 10.7 per 1000 person‐years for the reference group. The strongest associations were found for ADP inhibitors (OR 5.80), followed by anticoagulants treatment (OR 2.62) and prior ulcer (OR 2.68). The model performed well in terms of calibration and discriminatory power. Conclusion This study is the first to describe a model, which estimates the incidence rate of UGIB for patients using aspirin/NSAID, based on the specific combination of risk factors. Risk of upper gastrointestinal bleeding for a given patient can be accurately estimated using this model.

The Etiology and Outcome of Upper Gastrointestinal Bleeding in Patients Presenting to Tertiary Care Hospital, Karachi

“…Their findings are in favor of the findings shown in a Danish study in which more than 60% of the patients with non-variceal bleed presented with UGIB. 19,20 Findings from our study was contradictory with the above-mentioned studies as in our findings only 13 (2.4%) patients used NSAID and 23 (4.3%) patients used antiplatelet. Therefore, in our study use of NSAID was not the common cause of UGIB.…”

Derivation and validation of a risk prediction score for nonsteroidal anti‐inflammatory drug‐related serious gastrointestinal complications in the elderly

“…In one study, age, male sex, anaemia, aspirin and anticoagulants were identified as predictors, while GI history and cotreatment with corticosteroids and SSRIs were not 6 . In another study, age, history of GI bleeding or perforation, concomitant use of corticosteroids, SSRIs and antithrombotic agents, and male sex were identified 1 . In our study, concomitant PPI or H2RA treatment with NSAID reduced the risk of serious GI complications, whereas the use of rebamipide or Artemisia herb soft extract did not.…”

Effects of Hyperbaric Oxygen Therapy on the Expression of FGF, MMP-9 and Occludin in the Repair of Gastric Mucosal Erosions

“…9 The side effects of NSAIDs therapy can be even more severe, namely the occurrence of gastrointestinal bleeding. [10][11][12][13] Pharmacognosy Journal, Vol 14, Issue 3, May-June, 2022 COX-1 is inhibited it results in tissue ischemia. The role of COX-2 is to improve wound healing and inhibit adherent leukocytes.…”