Nitrovasodilators, Low-Dose Aspirin, Other Nonsteroidal Antiinflammatory Drugs, and the Risk of Upper Gastrointestinal Bleeding

• Published in: The New England journal of medicine Vol. 343; no. 12; pp. 834 - 839
• Main Authors: Lanas, Angel, Bajador, Eduardo, Serrano, Pedro, Fuentes, Javier, Carreño, Sofía, Guardia, Jesusa, Sanz, Mercedes, Montoro, Miguel, Sáinz, Ricardo
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 21.09.2000
• Subjects: Aged; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; antiinflammatory agents; Aspirin; Aspirin - adverse effects; Biological and medical sciences; bleeding; Case-Control Studies; Digestive system; Drug Interactions; Drug Therapy, Combination; Drug toxicity and drugs side effects treatment; Drugs; Esophagitis - chemically induced; Esophagitis - prevention & control; Female; Gastrointestinal Hemorrhage - chemically induced; Gastrointestinal Hemorrhage - prevention & control; gastrointestinal tract; Hemorrhage; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Nitrates - metabolism; Nitrates - therapeutic use; Nitric Oxide - metabolism; Odds Ratio; Peptic Ulcer Hemorrhage - chemically induced; Peptic Ulcer Hemorrhage - prevention & control; Pharmacology. Drug treatments; Risk Factors; Toxicity: digestive system; Ulcers; Vasodilator Agents - therapeutic use; Human; Vasodilator agent; Toxicity; Cardiovascular disease; Acetylsalicylic acid; Case control study; Risk analysis; Gastrointestinal; Hemorrhage; Vascular disease; Non steroidal antiinflammatory agent; Prospective; Chemotherapy; Nitric oxide; Nitroglycerin; Organic nitrate; Digestive diseases; Intestinal disease; Salicylates; Gastric disease
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM200009213431202

Nonsteroidal antiinflammatory drugs, including low-dose aspirin, induce gastrointestinal complications. 1 – 3 Although new and potentially safer nonsteroidal antiinflammatory drugs (such as cyclooxygenase-2 inhibitors) are now in use, 4 it is uncertain whether these new drugs will reduce the number of patients hospitalized with gastrointestinal bleeding. Over-the-counter nonsteroidal antiinflammatory drugs, especially aspirin, are the drugs most frequently associated with bleeding, 5 and the number of people taking low-dose aspirin is increasing. 3 Nonsteroidal antiinflammatory drugs that release nitric oxide are under investigation. 6 , 7 Nitric oxide increases blood flow in the gastric mucosa and inhibits the adherence of leukocytes to the endothelium within the gastrointestinal microcirculation. . . .