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

The latest issue of the Alimentary Pharmacology & Therapeutics investigates 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 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 examined the utilized of 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 a 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.

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

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

The team of doctors examined 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 commented, "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
18 March 2013

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