Observational study of upper gastrointestinal haemorrhage in elderly patients given selective cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs
Abstract Objective: To compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and non-selective non-steroidal anti-inflammatory drugs (NSAIDs). Design: Observational cohort study. Setting: Administrative data from Ontario, Cana...
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| Published in | BMJ Vol. 325; no. 7365; pp. 624 - 627 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
London
British Medical Journal Publishing Group
21.09.2002
British Medical Association BMJ Publishing Group Ltd BMJ Publishing Group LTD BMJ Publishing Group BMJ |
| Edition | International edition |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0959-8138 0959-8146 1756-1833 1468-5833 1756-1833 |
| DOI | 10.1136/bmj.325.7365.624 |
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| Abstract | Abstract Objective: To compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and non-selective non-steroidal anti-inflammatory drugs (NSAIDs). Design: Observational cohort study. Setting: Administrative data from Ontario, Canada, used from 17 April 2000 to 31 March 2001 to identify population based, NSAID-naive cohorts of patients. Patients: Subjects aged ≥ 66 years who started taking non-selective NSAIDs (n=5391), diclofenac plus misoprostol (n=5087), rofecoxib (n=14 583), or celecoxib (n=18 908) and a randomly selected control cohort not exposed to NSAIDs (n=100 000). Main outcome measures: Rate ratios of hospital admission for upper gastrointestinal haemorrhage in each drug cohort with adjustment for potential confounders. Results: Relative to controls, the multivariate model revealed an increased short term risk of upper gastrointestinal haemorrhage for users of non-selective NSAIDs (adjusted rate ratio 4.0 (95% confidence intervals 2.3 to 6.9)), diclofenac plus misoprostol (3.0 (1.7 to 5.6)), and rofecoxib (1.9 (1.3 to 2.8)) but not celecoxib (1.0 (0.7 to 1.6)). Relative to celecoxib, significantly higher risks of upper gastrointestinal haemorrhage were observed for non-selective NSAIDs (4.4 (2.3 to 8.5)), diclofenac plus misoprostol (3.2 (1.6 to 6.5)), and rofecoxib (1.9 (1.2 to 2.8)). Relative to rofecoxib, non-selective NSAID users were at significantly higher risk of upper gastrointestinal haemorrhage (1.9 (1.0 to 3.5)). Conclusions: This population based observational study found a lower short term risk of upper gastrointestinal haemorrhage for selective COX-2 inhibitors compared with non-selective NSAIDs. |
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| AbstractList | Objective To compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and non-selective non-steroidal anti-inflammatory drugs (NSAIDs). Design Observational cohort study. Setting Administrative data from Ontario, Canada, used from 17 April 2000 to 31 March 2001 to identify population based, NSAID-naive cohorts of patients. Patients Subjects aged ≥66 years who started taking non-selective NSAIDs (n=5391), diclofenac plus misoprostol (n=5087), rofecoxib (n=14 583), or celecoxib (n=18 908) and a randomly selected control cohort not exposed to NSAIDs (n=100 000). Main outcome measures Rate ratios of hospital admission for upper gastrointestinal haemorrhage in each drug cohort with adjustment for potential confounders. Results Relative to controls, the multivariate model revealed an increased short term risk of upper gastrointestinal haemorrhage for users of non-selective NSAIDs (adjusted rate ratio 4.0 (95% confidence intervals 2.3 to 6.9)), diclofenac plus misoprostol (3.0 (1.7 to 5.6)), and rofecoxib (1.9 (1.3 to 2.8)) but not celecoxib (1.0 (0.7 to 1.6)). Relative to celecoxib, significantly higher risks of upper gastrointestinal haemorrhage were observed for non-selective NSAIDs (4.4 (2.3 to 8.5)), diclofenac plus misoprostol (3.2 (1.6 to 6.5)), and rofecoxib (1.9 (1.2 to 2.8)). Relative to rofecoxib, non-selective NSAID users were at significantly higher risk of upper gastrointestinal haemorrhage (1.9 (1.0 to 3.5)). Conclusions This population based observational study found a lower short term risk of upper gastrointestinal haemorrhage for selective COX-2 inhibitors compared with non-selective NSAIDs. OBJECTIVE: To compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and non-selective non-steroidal anti-inflammatory drugs (NSAIDs). DESIGN: Observational cohort study. SETTING: Administrative data from Ontario, Canada, used from 17 April 2000 to 31 March 2001 to identify population based, NSAID-naive cohorts of patients. PATIENTS: Subjects aged > or =66 years who started taking non-selective NSAIDs (n=5391), diclofenac plus misoprostol (n=5087), rofecoxib (n=14 583), or celecoxib (n=18 908) and a randomly selected control cohort not exposed to NSAIDs (n=100 000). MAIN OUTCOME MEASURES: Rate ratios of hospital admission for upper gastrointestinal haemorrhage in each drug cohort with adjustment for potential confounders. RESULTS: Relative to controls, the multivariate model revealed an increased short term risk of upper gastrointestinal haemorrhage for users of non-selective NSAIDs (adjusted rate ratio 4.0 (95% confidence intervals 2.3 to 6.9)), diclofenac plus misoprostol (3.0 (1.7 to 5.6)), and rofecoxib (1.9 (1.3 to 2.8)) but not celecoxib (1.0 (0.7 to 1.6)). Relative to celecoxib, significantly higher risks of upper gastrointestinal haemorrhage were observed for non-selective NSAIDs (4.4 (2.3 to 8.5)), diclofenac plus misoprostol (3.2 (1.6 to 6.5)), and rofecoxib (1.9 (1.2 to 2.8)). Relative to rofecoxib, non-selective NSAID users were at significantly higher risk of upper gastrointestinal haemorrhage (1.9 (1.0 to 3.5)). CONCLUSIONS: This population based observational study found a lower short term risk of upper gastrointestinal haemorrhage for selective COX-2 inhibitors compared with non-selective NSAIDs. Abstract Objective: To compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and non-selective non-steroidal anti-inflammatory drugs (NSAIDs). Design: Observational cohort study. Setting: Administrative data from Ontario, Canada, used from 17 April 2000 to 31 March 2001 to identify population based, NSAID-naive cohorts of patients. Patients: Subjects aged ≥ 66 years who started taking non-selective NSAIDs (n=5391), diclofenac plus misoprostol (n=5087), rofecoxib (n=14 583), or celecoxib (n=18 908) and a randomly selected control cohort not exposed to NSAIDs (n=100 000). Main outcome measures: Rate ratios of hospital admission for upper gastrointestinal haemorrhage in each drug cohort with adjustment for potential confounders. Results: Relative to controls, the multivariate model revealed an increased short term risk of upper gastrointestinal haemorrhage for users of non-selective NSAIDs (adjusted rate ratio 4.0 (95% confidence intervals 2.3 to 6.9)), diclofenac plus misoprostol (3.0 (1.7 to 5.6)), and rofecoxib (1.9 (1.3 to 2.8)) but not celecoxib (1.0 (0.7 to 1.6)). Relative to celecoxib, significantly higher risks of upper gastrointestinal haemorrhage were observed for non-selective NSAIDs (4.4 (2.3 to 8.5)), diclofenac plus misoprostol (3.2 (1.6 to 6.5)), and rofecoxib (1.9 (1.2 to 2.8)). Relative to rofecoxib, non-selective NSAID users were at significantly higher risk of upper gastrointestinal haemorrhage (1.9 (1.0 to 3.5)). Conclusions: This population based observational study found a lower short term risk of upper gastrointestinal haemorrhage for selective COX-2 inhibitors compared with non-selective NSAIDs. To compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and non-selective non-steroidal anti-inflammatory drugs (NSAIDs).OBJECTIVETo compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and non-selective non-steroidal anti-inflammatory drugs (NSAIDs).Observational cohort study.DESIGNObservational cohort study.Administrative data from Ontario, Canada, used from 17 April 2000 to 31 March 2001 to identify population based, NSAID-naive cohorts of patients.SETTINGAdministrative data from Ontario, Canada, used from 17 April 2000 to 31 March 2001 to identify population based, NSAID-naive cohorts of patients.Subjects aged > or =66 years who started taking non-selective NSAIDs (n=5391), diclofenac plus misoprostol (n=5087), rofecoxib (n=14 583), or celecoxib (n=18 908) and a randomly selected control cohort not exposed to NSAIDs (n=100 000).PATIENTSSubjects aged > or =66 years who started taking non-selective NSAIDs (n=5391), diclofenac plus misoprostol (n=5087), rofecoxib (n=14 583), or celecoxib (n=18 908) and a randomly selected control cohort not exposed to NSAIDs (n=100 000).Rate ratios of hospital admission for upper gastrointestinal haemorrhage in each drug cohort with adjustment for potential confounders.MAIN OUTCOME MEASURESRate ratios of hospital admission for upper gastrointestinal haemorrhage in each drug cohort with adjustment for potential confounders.Relative to controls, the multivariate model revealed an increased short term risk of upper gastrointestinal haemorrhage for users of non-selective NSAIDs (adjusted rate ratio 4.0 (95% confidence intervals 2.3 to 6.9)), diclofenac plus misoprostol (3.0 (1.7 to 5.6)), and rofecoxib (1.9 (1.3 to 2.8)) but not celecoxib (1.0 (0.7 to 1.6)). Relative to celecoxib, significantly higher risks of upper gastrointestinal haemorrhage were observed for non-selective NSAIDs (4.4 (2.3 to 8.5)), diclofenac plus misoprostol (3.2 (1.6 to 6.5)), and rofecoxib (1.9 (1.2 to 2.8)). Relative to rofecoxib, non-selective NSAID users were at significantly higher risk of upper gastrointestinal haemorrhage (1.9 (1.0 to 3.5)).RESULTSRelative to controls, the multivariate model revealed an increased short term risk of upper gastrointestinal haemorrhage for users of non-selective NSAIDs (adjusted rate ratio 4.0 (95% confidence intervals 2.3 to 6.9)), diclofenac plus misoprostol (3.0 (1.7 to 5.6)), and rofecoxib (1.9 (1.3 to 2.8)) but not celecoxib (1.0 (0.7 to 1.6)). Relative to celecoxib, significantly higher risks of upper gastrointestinal haemorrhage were observed for non-selective NSAIDs (4.4 (2.3 to 8.5)), diclofenac plus misoprostol (3.2 (1.6 to 6.5)), and rofecoxib (1.9 (1.2 to 2.8)). Relative to rofecoxib, non-selective NSAID users were at significantly higher risk of upper gastrointestinal haemorrhage (1.9 (1.0 to 3.5)).This population based observational study found a lower short term risk of upper gastrointestinal haemorrhage for selective COX-2 inhibitors compared with non-selective NSAIDs.CONCLUSIONSThis population based observational study found a lower short term risk of upper gastrointestinal haemorrhage for selective COX-2 inhibitors compared with non-selective NSAIDs. To compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and non-selective non-steroidal anti-inflammatory drugs (NSAIDs). Observational cohort study. Administrative data from Ontario, Canada, used from 17 April 2000 to 31 March 2001 to identify population based, NSAID-naive cohorts of patients. Subjects aged > or =66 years who started taking non-selective NSAIDs (n=5391), diclofenac plus misoprostol (n=5087), rofecoxib (n=14 583), or celecoxib (n=18 908) and a randomly selected control cohort not exposed to NSAIDs (n=100 000). Rate ratios of hospital admission for upper gastrointestinal haemorrhage in each drug cohort with adjustment for potential confounders. Relative to controls, the multivariate model revealed an increased short term risk of upper gastrointestinal haemorrhage for users of non-selective NSAIDs (adjusted rate ratio 4.0 (95% confidence intervals 2.3 to 6.9)), diclofenac plus misoprostol (3.0 (1.7 to 5.6)), and rofecoxib (1.9 (1.3 to 2.8)) but not celecoxib (1.0 (0.7 to 1.6)). Relative to celecoxib, significantly higher risks of upper gastrointestinal haemorrhage were observed for non-selective NSAIDs (4.4 (2.3 to 8.5)), diclofenac plus misoprostol (3.2 (1.6 to 6.5)), and rofecoxib (1.9 (1.2 to 2.8)). Relative to rofecoxib, non-selective NSAID users were at significantly higher risk of upper gastrointestinal haemorrhage (1.9 (1.0 to 3.5)). This population based observational study found a lower short term risk of upper gastrointestinal haemorrhage for selective COX-2 inhibitors compared with non-selective NSAIDs. Objective: To compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and non-selective non-steroidal anti-inflammatory drugs (NSAIDs). Design: Observational cohort study. Setting: Administrative data from Ontario, Canada, used from 17 April 2000 to 31 March 2001 to identify population based, NSAID-naive cohorts of patients. Patients: Subjects aged ≥ 66 years who started taking non-selective NSAIDs (n=5391), diclofenac plus misoprostol (n=5087), rofecoxib (n=14 583), or celecoxib (n=18 908) and a randomly selected control cohort not exposed to NSAIDs (n=100 000). Main outcome measures: Rate ratios of hospital admission for upper gastrointestinal haemorrhage in each drug cohort with adjustment for potential confounders. Results: Relative to controls, the multivariate model revealed an increased short term risk of upper gastrointestinal haemorrhage for users of non-selective NSAIDs (adjusted rate ratio 4.0 (95% confidence intervals 2.3 to 6.9)), diclofenac plus misoprostol (3.0 (1.7 to 5.6)), and rofecoxib (1.9 (1.3 to 2.8)) but not celecoxib (1.0 (0.7 to 1.6)). Relative to celecoxib, significantly higher risks of upper gastrointestinal haemorrhage were observed for non-selective NSAIDs (4.4 (2.3 to 8.5)), diclofenac plus misoprostol (3.2 (1.6 to 6.5)), and rofecoxib (1.9 (1.2 to 2.8)). Relative to rofecoxib, non-selective NSAID users were at significantly higher risk of upper gastrointestinal haemorrhage (1.9 (1.0 to 3.5)). Conclusions: This population based observational study found a lower short term risk of upper gastrointestinal haemorrhage for selective COX-2 inhibitors compared with non-selective NSAIDs. Abstract Objective: To compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and non-selective non-steroidal anti-inflammatory drugs (NSAIDs). Design: Observational cohort study. Setting: Administrative data from Ontario, Canada, used from 17 April 2000 to 31 March 2001 to identify population based, NSAID-naive cohorts of patients. Patients: Subjects aged â[per thousand]¥ 66 years who started taking non-selective NSAIDs (n=5391), diclofenac plus misoprostol (n=5087), rofecoxib (n=14 583), or celecoxib (n=18 908) and a randomly selected control cohort not exposed to NSAIDs (n=100 000). Main outcome measures: Rate ratios of hospital admission for upper gastrointestinal haemorrhage in each drug cohort with adjustment for potential confounders. Results: Relative to controls, the multivariate model revealed an increased short term risk of upper gastrointestinal haemorrhage for users of non-selective NSAIDs (adjusted rate ratio 4.0 (95% confidence intervals 2.3 to 6.9)), diclofenac plus misoprostol (3.0 (1.7 to 5.6)), and rofecoxib (1.9 (1.3 to 2.8)) but not celecoxib (1.0 (0.7 to 1.6)). Relative to celecoxib, significantly higher risks of upper gastrointestinal haemorrhage were observed for non-selective NSAIDs (4.4 (2.3 to 8.5)), diclofenac plus misoprostol (3.2 (1.6 to 6.5)), and rofecoxib (1.9 (1.2 to 2.8)). Relative to rofecoxib, non-selective NSAID users were at significantly higher risk of upper gastrointestinal haemorrhage (1.9 (1.0 to 3.5)). Conclusions: This population based observational study found a lower short term risk of upper gastrointestinal haemorrhage for selective COX-2 inhibitors compared with non-selective NSAIDs. |
| Audience | Professional |
| Author | Rochon, Paula A Austin, Peter C Kopp, Alex Laupacis, Andreas Naglie, Gary Juurlink, David N Anderson, Geoffrey M Mamdani, Muhammad |
| AuthorAffiliation | a Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue-G215, Toronto, Ontario, Canada, b Kunin Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Toronto, c Sunnybrook and Women's College Health Sciences Centre, Toronto, d Department of health policy, management, and evaluation, Faculty of Medicine, University of Toronto, e University of Toronto |
| AuthorAffiliation_xml | – name: a Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue-G215, Toronto, Ontario, Canada, b Kunin Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Toronto, c Sunnybrook and Women's College Health Sciences Centre, Toronto, d Department of health policy, management, and evaluation, Faculty of Medicine, University of Toronto, e University of Toronto |
| Author_xml | – sequence: 1 givenname: Muhammad surname: Mamdani fullname: Mamdani, Muhammad email: muhammad.mamdani@ices.on.ca organization: a Institute for Clinical Evaluative Sciences, Bayview Avenue-G, Toronto, Ontario, Canada – sequence: 2 givenname: Paula A surname: Rochon fullname: Rochon, Paula A organization: b Kunin Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Toronto – sequence: 3 givenname: David N surname: Juurlink fullname: Juurlink, David N organization: c Sunnybrook and Women's College Health Sciences Centre, Toronto – sequence: 4 givenname: Alex surname: Kopp fullname: Kopp, Alex organization: a Institute for Clinical Evaluative Sciences, Bayview Avenue-G, Toronto, Ontario, Canada – sequence: 5 givenname: Geoffrey M surname: Anderson fullname: Anderson, Geoffrey M organization: d Department of health policy, management, and evaluation, Faculty of Medicine, University of Toronto – sequence: 6 givenname: Gary surname: Naglie fullname: Naglie, Gary organization: e University of Toronto – sequence: 7 givenname: Peter C surname: Austin fullname: Austin, Peter C organization: a Institute for Clinical Evaluative Sciences, Bayview Avenue-G, Toronto, Ontario, Canada – sequence: 8 givenname: Andreas surname: Laupacis fullname: Laupacis, Andreas organization: a Institute for Clinical Evaluative Sciences, Bayview Avenue-G, Toronto, Ontario, Canada |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13919823$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/12242172$$D View this record in MEDLINE/PubMed |
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| Keywords | Prostaglandin-endoperoxide synthase Rofecoxib Isozyme Toxicity Cardiovascular disease Gastrointestinal Epidemiology Hemorrhage Misoprostol Diclofenac Vascular disease Cohort study Intestinal disease Gastric disease Human Enzyme Enzyme inhibitor Celecoxib Non steroidal antiinflammatory agent Arylacetic acid derivatives Digestive diseases Oxidoreductases Elderly Comparative study Prostaglandin derivatives |
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| Notes | istex:8D23589E1F9587312C5FC61F4314AB8602F46EB0 ark:/67375/NVC-QP2P17ZM-S local:bmj;325/7365/624 ArticleID:bmj.325.7365.624 PMID:12242172 Correspondence to: M Mamdani href:bmj-325-624-1.pdf ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23 Correspondence to: M Mamdani muhammad.mamdani@ices.on.ca Contributors: MM, PAR, DNJ, GMA, GN, and AL designed the study; MM, DNJ, PCA, and AK performed the study. GN, PCA, and AL advised and supervised. Statistical advice was given by PCA. MM is the guarantor. |
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| References | Bombardier, Laine, Reicin, Shapiro, Burgos-Vargas, Davis 2000; 343 Waskewich, Blumenthal, Li, Stein, Goldenberg, Burton 2002; 62 Raiford, Gutthann, Rodriguez 1996; 7 Hernandez-Diaz, Rodriguez 2002; 55 Fitzgerald, Patrono 2001; 345 1990; 28 Juni, Rutjes, Dieppe 2002; 324 Hernandez-Diaz, Rodriguez 2000; 160 Griffin, Piper, Daugherty, Snowden, Ray 1991; 114 Lassila, Stoehr, Ganguli, Seaberg, Gilby, Belle 1996; 30 Henry, Lim, Garcia Rodriguez, Perez Gutthann, Carson, Griffin 1996; 312 Patti, Gumired, Reddanna, Sutton, Phillips, Reddy 2002; 180 Hawkey 1999; 353 Patrignani, Panara, Sciulli, Santini, Renda, Patrono 1997; 48 Blain, Boileau, Lapicque, Nedelec, Loeuille, Guillaume 2002; 53 Hawk, Viner, Dannenberg, Dubois 2002; 94 Aalykke, Lauritsen 2001; 15 Silverstein, Faich, Goldstein, Simon, Pincus, Whelton 2000; 284 Barat, Andreasen, Damsgaard 2000; 56 Warner, Giuliano, Vojnovic, Bukasa, Mitchell, Vane 1999; 96 Schneeweiss, Seeger, Maclure, Wang, Avorn, Glynn 2001; 154 Gabriel, Jaakkimainen, Bombardier 1991; 115 Charlson, Pompei, Ales, MacKenzie 1987; 40 Feldman, McMahon 2000; 132 12242157 - BMJ. 2002 Sep 21;325(7365):607-8 |
| References_xml | – volume: 7 start-page: 101 year: 1996 article-title: Positive predictive value of ICD.9 codes in the identification of cases of complicated peptic ulcer disease in the Saskatchewan hospital automated database. publication-title: Epidemiology – volume: 53 start-page: 255 year: 2002 article-title: Limitation of the in vitro whole blood assay for predicting the COX selectivity of NSAIDs in clinical use. publication-title: Br J Clin Pharmacol – volume: 62 start-page: 2029 year: 2002 article-title: Celecoxib exhibits the greatest potency amongst cyclooxygenase (COX) inhibitors for growth inhibition of COX-2-negative hematopoietic and epithelial cell lines. publication-title: Cancer Res – volume: 160 start-page: 2093 year: 2000 article-title: Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: an overview of epidemiologic studies published in the 1990s. publication-title: Arch Intern Med – volume: 154 start-page: 854 year: 2001 article-title: Performance of comorbidity scores to control for confounding in epidemiologic studies using claims data. publication-title: Am J Epidemiol – volume: 96 start-page: 7563 year: 1999 article-title: Nonsteroid drug selectivities for cyclo-oxygenase-1 rather than cyclo-oxygenase-2 are associated with human gastrointestinal toxicity: a full in vitro analysis. publication-title: Proc Natl Acad Sci U S A – volume: 114 start-page: 257 year: 1991 article-title: Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. publication-title: Ann Intern Med – volume: 343 start-page: 1520 year: 2000 article-title: Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. publication-title: N Engl J Med – volume: 284 start-page: 1247 year: 2000 article-title: Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. publication-title: JAMA – volume: 30 start-page: 589 year: 1996 article-title: Use of prescription medications in an elderly rural population: the MoVIES Project. publication-title: Ann Pharmacother – volume: 56 start-page: 501 year: 2000 article-title: The consumption of drugs by 75-year-old individuals living in their own homes. publication-title: Eur J Clin Pharmacol – volume: 48 start-page: 623 year: 1997 article-title: Differential inhibition of human prostaglandin endoperoxide synthase-1 and -2 by nonsteroidal anti-inflammatory drugs. publication-title: J Physiol Pharmacol – volume: 94 start-page: 545 year: 2002 article-title: COX-2 in cancera player that's defining the rules. publication-title: J Natl Cancer Inst – volume: 115 start-page: 787 year: 1991 article-title: Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis. publication-title: Ann Intern Med – volume: 353 start-page: 307 year: 1999 article-title: COX-2 inhibitors. publication-title: Lancet – volume: 15 start-page: 705 year: 2001 article-title: Epidemiology of NSAID-related gastroduodenal mucosal injury. publication-title: Best Pract Res Clin Gastroenterol – volume: 132 start-page: 134 year: 2000 article-title: Do cyclooxygenase-2 inhibitors provide benefits similar to those of traditional nonsteroidal anti-inflammatory drugs, with less gastrointestinal toxicity? publication-title: Ann Intern Med – volume: 312 start-page: 1563 year: 1996 article-title: Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. publication-title: BMJ – volume: 55 start-page: 157 year: 2002 article-title: Incidence of serious upper gastrointestinal bleeding/perforation in the general population: review of epidemiologic studies. publication-title: J Clin Epidemiol – volume: 180 start-page: 13 issue: 1 year: 2002 article-title: Overexpression of cyclooxygenase-2 (COX-2) in human primitive neuroectodermal tumors: effect of celecoxib and rofecoxib. publication-title: Cancer Lett – volume: 40 start-page: 373 year: 1987 article-title: A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. publication-title: J Chron Dis – volume: 345 start-page: 433 year: 2001 article-title: The coxibs, selective inhibitors of cyclooxygenase-2. publication-title: N Engl J Med – volume: 28 start-page: 25 year: 1990 article-title: Misoprostol for co-prescription with NSAIDs. publication-title: Drug Ther Bull – volume: 324 start-page: 1287 year: 2002 article-title: Are the COX 2 inhibitors superior to traditional non-steroidal anti-inflammatory drugs? publication-title: BMJ – reference: 12242157 - BMJ. 2002 Sep 21;325(7365):607-8 |
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| Snippet | Abstract Objective: To compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and... Objective: To compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and non-selective... Objective To compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and non-selective... To compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and non-selective... OBJECTIVE: To compare rates of upper gastrointestinal haemorrhage among elderly patients given selective cyclo-oxygenase-2 (COX 2) inhibitors and non-selective... |
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| SubjectTerms | Aged Anti-Inflammatory Agents, Non-Steroidal - adverse effects Biological and medical sciences Celecoxib Cohort Studies Complications and side effects Control groups COX-2 inhibitors Cyclooxygenase 2 Diclofenac - adverse effects Drug Combinations Drug prescriptions Drug therapy Drug toxicity and drugs side effects treatment Female Follow-Up Studies Gastrointestinal agents Gastrointestinal bleeding Gastrointestinal hemorrhage Gastrointestinal Hemorrhage - chemically induced Hemorrhage Hospitalization Hospitalization - statistics & numerical data Humans Isoenzymes - antagonists & inhibitors Lactones - adverse effects Male Medical disorders Medical sciences Membrane Proteins Misoprostol - adverse effects Multivariate Analysis Nonsteroidal anti-inflammatory agents Nonsteroidal anti-inflammatory drugs Nonsteroidal antiinflammatory agents Observational studies Older adults Pharmaceuticals Pharmacology. Drug treatments Prescription drugs Proportional Hazards Models Prostaglandin-Endoperoxide Synthases Pyrazoles Risk Factors Small intestine Stomach Sulfonamides - adverse effects Sulfones Toxicity: digestive system |
| Title | Observational study of upper gastrointestinal haemorrhage in elderly patients given selective cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs |
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