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Prophylactic gastroprotective therapy in NSAID- and aspirin-associated ulcer bleeding

A study published ahead of print in the Alimentary Pharmacology & Therapeutics examines the use of prophylactic gastroprotective therapy in patients with nonsteroidal anti-inflammatory drug- and aspirin-associated ulcer bleeding.

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Poor adherence to gastroprotective agents is common among users of nonsteroidal anti-inflammatory drugs (NSAIDS) or low-dose aspirin.

There are little data on the utilization of gastroprotective agents among nonsteroidal anti-inflammatory drugs and low-dose aspirin  users complicated by ulcer bleeding.

Dr Ho and colleagues from Hong Kong utilized gastroprotective agents among nonsteroidal anti-inflammatory drugs and low-dose aspirin ulcers before the onset of ulcer bleeding.

The researchers conducted a cross-sectional study to determine the exposure to nonsteroidal anti-inflammatory drugs, low-dose aspirin, and gastroprotective agents within 4 weeks before endoscopically confirmed ulcer bleeding.

The team of doctors performed sensitivity analysis to study how improving adherence to gastroprotective agents use would reduce the risk of ulcer bleeding in high-risk users.

Between 2000 and 2009, 1093 and 2277 patients had nonsteroidal anti-inflammatory drugs and low-dose aspirin associated ulcer bleeding respectively.

The researchers examined that the incidence of nonsteroidal anti-inflammatory drugs associated ulcer bleeding declined by 40%, whereas that of low-dose aspirin  associated ulcer bleeding increased by 46%.

The team found that 39% of nonsteroidal anti-inflammatory drugs users, and 75% of low-dose aspirin  users belonged to high ulcer risk category.

Low-dose aspirin associated ulcer bleeding increased by 46%
Alimentary Pharmacology & Therapeutics

The research team noted that although gastroprotective agents prescription rate has increased over time, only 42% and 31% of high-risk nonsteroidal anti-inflammatory drugs and low-dose aspirin users received gastroprotective agents before ulcer bleeding, respectively.

Sensitivity analysis showed that if gastroprotective agents could reduce bleeding risk by 50%, improving adherence would prevent up to 35% of ulcer bleeding in high-risk users.

Dr Ho's team concluded, "A substantial proportion of high-risk nonsteroidal anti-inflammatory drugs and low-dose aspirin users had not received prophylaxis with gastroprotective agents before ulcer bleeding."

"These bleeding episodes may be preventable with better adherence to gastroprotective agent use."

Aliment Pharmacol Ther 2013: DOI: 10.1111/apt.12259
01 March 2013

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