Identification of NSAID Users at Risk for Gastrointestinal Complications A Systematic Review of Current Guidelines and Consensus Agreements

• Published in: Drug safety Vol. 33; no. 6; pp. 443 - 453
• Main Authors: Tielemans, Merel M., Eikendal, Ties, Jansen, Jan B. M. J., van Oijen, Martijn G. H.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2010; Adis International; Wolters Kluwer Health, Inc; Springer Nature B.V
• Subjects: Analysis; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Clinical Protocols; Clinical trial. Drug monitoring; Complications and side effects; Consensus; Dosage and administration; Drug Safety and Pharmacovigilance; Drug toxicity and drugs side effects treatment; Gastrointestinal diseases; Gastrointestinal Diseases - chemically induced; General pharmacology; Guidelines as Topic; Health risk assessment; Helicobacter pylori; Humans; Medical sciences; Medicine; Medicine & Public Health; Methods; Nonprescription Drugs - adverse effects; Nonsteroidal anti-inflammatory drugs; Pharmacology. Drug treatments; Pharmacology/Toxicology; Practice guidelines (Medicine); Prevention; Review Article; Risk Factors; Toxicity: digestive system; Netherlands; Clopidogrel; Nsaid User; Peptic Ulcer Disease; Gastrointestinal Complication; Traditional Nsaid; User; Toxicity; Spirillaceae; Systematic review; Identification; Review; Gastrointestinal; Helicobacter pylori; Secondary effect; Bacteria; Complication; Human; Stomach; Drug combination; Spirillales; Digestive system; Gut; Pharmacovigilance; Consensus; Recommendation; Non steroidal antiinflammatory agent; Symptomatology; Concomitant disease; Risk factor; Application method
• ISSN: 0114-5916; 1179-1942
• DOI: 10.2165/11534590-000000000-00000

NSAIDs are among the most often used drugs worldwide. Numerous NSAID users are at risk for developing gastrointestinal complications. The purpose of this review was to identify and stratify risk factors for gastrointestinal complications in NSAID users documented in guidelines and consensus agreements, and to collect recommendations regarding over-the-counter (OTC) NSAID use. To facilitate this, a PubMed search from 1 January 1999 until 1 March 2009 was performed, resulting in the inclusion of nine English-language guidelines in our analysis. Risk factors were defined as ‘definite’ if mentioned in all guidelines; otherwise they were defined as ‘controversial’ risk factors. ‘Definite’ risk factors were a history of (complicated) peptic ulcer disease, older age (cut-off range 60–75 years), concomitant anticoagulant or corticosteroid use and multiple NSAID use, including low-dose aspirin (acetylsalicylic acid). ‘Controversial’ risk factors were high-dose NSAID use, concomitant clopidogrel or selective serotonin reuptake inhibitor use, a history of gastrointestinal symptoms, rheumatoid arthritis disability and cardiovascular disease. Infection with Helicobacter pylori was identified as an additive risk factor. Risk factors in OTC NSAID users were difficult to identify in the current literature. Risk factors were not all uniformly present in analysed guidelines and consensus agreements. We identified a history of (complicated) peptic ulcer disease, older age, concomitant anticoagulant or corticosteroid use and multiple NSAID use, including low-dose aspirin, as definite gastrointestinal risk factors in NSAID users.