Nitrovasodilators, Low-Dose Aspirin, Other Nonsteroidal Antiinflammatory Drugs, and the Risk of Upper Gastrointestinal Bleeding
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...
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| Published in | The New England journal of medicine Vol. 343; no. 12; pp. 834 - 839 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Boston, MA
Massachusetts Medical Society
21.09.2000
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0028-4793 1533-4406 |
| DOI | 10.1056/NEJM200009213431202 |
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| Abstract | 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. . . . |
|---|---|
| AbstractList | BACKGROUND The relation between medications that release nitric oxide, such as nitroglycerin and other nitrovasodilators, and upper gastrointestinal bleeding is uncertain. In animals, these medications reduce the gastric damage induced by nonsteroidal antiinflammatory drugs. Nitric oxide, however, inhibits platelet aggregation and may contribute to bleeding from an ulcer.UNLABELLEDBACKGROUND The relation between medications that release nitric oxide, such as nitroglycerin and other nitrovasodilators, and upper gastrointestinal bleeding is uncertain. In animals, these medications reduce the gastric damage induced by nonsteroidal antiinflammatory drugs. Nitric oxide, however, inhibits platelet aggregation and may contribute to bleeding from an ulcer.We performed a case-control study to determine the risk of bleeding in patients taking nitrovasodilators, low-dose aspirin, or other nonsteroidal antiinflammatory drugs. The case group was made up of 1122 consecutive patients admitted to one of four hospitals with bleeding from a peptic lesion. The 2231 control subjects were 1109 patients hospitalized for other reasons and 1122 outpatients from the same geographic area.METHODSWe performed a case-control study to determine the risk of bleeding in patients taking nitrovasodilators, low-dose aspirin, or other nonsteroidal antiinflammatory drugs. The case group was made up of 1122 consecutive patients admitted to one of four hospitals with bleeding from a peptic lesion. The 2231 control subjects were 1109 patients hospitalized for other reasons and 1122 outpatients from the same geographic area.In the week before admission, 520 (46.3 percent) of the patients with bleeding had taken a nonsteroidal antiinflammatory drug other than low-dose aspirin, 120 (10.7 percent) had taken low-dose aspirin (< or = 300 mg per day), 60 (5.3 percent) a nitrovasodilator, and 135 (12.0 percent) an antisecretory agent such as a histamine H2-receptor antagonist or a proton-pump inhibitor. In multivariate models that adjusted for age, sex, and clinical risk factors, the use of a nonsteroidal antiinflammatory drug other than low-dose aspirin was independently associated with an increased risk of bleeding from a peptic ulcer (odds ratio, 7.4; 95 percent confidence interval, 4.5 to 12.0), as was the use of low-dose aspirin alone (odds ratio, 2.4; 95 percent confidence interval, 1.8 to 3.3). The use of a nitrovasodilator was associated with a decreased risk of bleeding (odds ratio, 0.6; 95 percent confidence interval, 0.4 to 0.9), as was antisecretory therapy (odds ratio, 0.6; 95 percent confidence interval, 0.4 to 0.8). In patients taking any type of nonsteroidai antiinflammatory drug, the use of a nitrovasodilator or antisecretory therapy was independently associated with a decreased risk of bleeding.RESULTSIn the week before admission, 520 (46.3 percent) of the patients with bleeding had taken a nonsteroidal antiinflammatory drug other than low-dose aspirin, 120 (10.7 percent) had taken low-dose aspirin (< or = 300 mg per day), 60 (5.3 percent) a nitrovasodilator, and 135 (12.0 percent) an antisecretory agent such as a histamine H2-receptor antagonist or a proton-pump inhibitor. In multivariate models that adjusted for age, sex, and clinical risk factors, the use of a nonsteroidal antiinflammatory drug other than low-dose aspirin was independently associated with an increased risk of bleeding from a peptic ulcer (odds ratio, 7.4; 95 percent confidence interval, 4.5 to 12.0), as was the use of low-dose aspirin alone (odds ratio, 2.4; 95 percent confidence interval, 1.8 to 3.3). The use of a nitrovasodilator was associated with a decreased risk of bleeding (odds ratio, 0.6; 95 percent confidence interval, 0.4 to 0.9), as was antisecretory therapy (odds ratio, 0.6; 95 percent confidence interval, 0.4 to 0.8). In patients taking any type of nonsteroidai antiinflammatory drug, the use of a nitrovasodilator or antisecretory therapy was independently associated with a decreased risk of bleeding.The use of nitrovasodilator drugs is independently associated with a decreased risk of upper gastrointestinal bleeding.CONCLUSIONSThe use of nitrovasodilator drugs is independently associated with a decreased risk of upper gastrointestinal bleeding. Background The relation between medications that release nitric oxide, such as nitroglycerin and other nitrovasodilators, and upper gastrointestinal bleeding is uncertain. In animals, these medications reduce the gastric damage induced by nonsteroidal antiinflammatory drugs. Nitric oxide, however, inhibits platelet aggregation and may contribute to bleeding from an ulcer. Methods We performed a case-control study to determine the risk of bleeding in patients taking nitrovasodilators, low-dose aspirin, or other nonsteroidal antiinflammatory drugs. The case group was made up of 1122 consecutive patients admitted to one of four hospitals with bleeding from a peptic lesion. The 2231 control subjects were 1109 patients hospitalized for other reasons and 1122 outpatients from the same geographic area. Results In the week before admission, 520 (46.3 percent) of the patients with bleeding had taken a nonsteroidal antiinflammatory drug other than low-dose aspirin, 120 (10.7 percent) had taken low-dose aspirin (≤300 mg per day), 60 (5.3 percent) a nitrovasodilator, and 135 (12.0 percent) an antisecretory agent such as a histamine H2 -receptor antagonist or a proton-pump inhibitor. In multivariate models that adjusted for age, sex, and clinical risk factors, the use of a nonsteroidal antiinflammatory drug other than low-dose aspirin was independently associated with an increased risk of bleeding from a peptic ulcer (odds ratio, 7.4; 95 percent confidence interval, 4.5 to 12.0), as was the use of low-dose aspirin alone (odds ratio, 2.4; 95 percent confidence interval, 1.8 to 3.3). The use of a nitrovasodilator was associated with a decreased risk of bleeding (odds ratio, 0.6; 95 percent confidence interval, 0.4 to 0.9), as was antisecretory therapy (odds ratio, 0.6; 95 percent confidence interval, 0.4 to 0.8). In patients taking any type of nonsteroidal antiinflammatory drug, the use of a nitrovasodilator or antisecretory therapy was independently associated with a decreased risk of bleeding. Conclusions The use of nitrovasodilator drugs is independently associated with a decreased risk of upper gastrointestinal bleeding. 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. . . . BACKGROUND The relation between medications that release nitric oxide, such as nitroglycerin and other nitrovasodilators, and upper gastrointestinal bleeding is uncertain. In animals, these medications reduce the gastric damage induced by nonsteroidal antiinflammatory drugs. Nitric oxide, however, inhibits platelet aggregation and may contribute to bleeding from an ulcer. We performed a case-control study to determine the risk of bleeding in patients taking nitrovasodilators, low-dose aspirin, or other nonsteroidal antiinflammatory drugs. The case group was made up of 1122 consecutive patients admitted to one of four hospitals with bleeding from a peptic lesion. The 2231 control subjects were 1109 patients hospitalized for other reasons and 1122 outpatients from the same geographic area. In the week before admission, 520 (46.3 percent) of the patients with bleeding had taken a nonsteroidal antiinflammatory drug other than low-dose aspirin, 120 (10.7 percent) had taken low-dose aspirin (< or = 300 mg per day), 60 (5.3 percent) a nitrovasodilator, and 135 (12.0 percent) an antisecretory agent such as a histamine H2-receptor antagonist or a proton-pump inhibitor. In multivariate models that adjusted for age, sex, and clinical risk factors, the use of a nonsteroidal antiinflammatory drug other than low-dose aspirin was independently associated with an increased risk of bleeding from a peptic ulcer (odds ratio, 7.4; 95 percent confidence interval, 4.5 to 12.0), as was the use of low-dose aspirin alone (odds ratio, 2.4; 95 percent confidence interval, 1.8 to 3.3). The use of a nitrovasodilator was associated with a decreased risk of bleeding (odds ratio, 0.6; 95 percent confidence interval, 0.4 to 0.9), as was antisecretory therapy (odds ratio, 0.6; 95 percent confidence interval, 0.4 to 0.8). In patients taking any type of nonsteroidai antiinflammatory drug, the use of a nitrovasodilator or antisecretory therapy was independently associated with a decreased risk of bleeding. The use of nitrovasodilator drugs is independently associated with a decreased risk of upper gastrointestinal bleeding. The relation between medications that release nitric oxide, such as nitroglycerin and other nitrovasodilators, and upper gastrointestinal bleeding is uncertain. In animals, these medications reduce the gastric damage induced by nonsteroidal antiinflammatory drugs. Nitric oxide, however, inhibits platelet aggregation and may contribute to bleeding from an ulcer. We performed a case-control study to determine the risk of bleeding in patients taking nitrovasodilators, low-dose aspirin, or other nonsteroidal antiinflammatory drugs. The case group was made up of 1122 consecutive patients admitted to one of four hospitals with bleeding from a peptic lesion. The 2231 control subjects were 1109 patients hospitalized for other reasons and 1122 outpatients from the same geographic area. The use of nitrovasodilator drugs is independently associated with a decreased risk of upper gastrointestinal bleeding. |
| Author | Carreño, Sofía Sáinz, Ricardo Serrano, Pedro Bajador, Eduardo Sanz, Mercedes Fuentes, Javier Montoro, Miguel Lanas, Angel Guardia, Jesusa |
| Author_xml | – sequence: 1 givenname: Angel surname: Lanas fullname: Lanas, Angel – sequence: 2 givenname: Eduardo surname: Bajador fullname: Bajador, Eduardo – sequence: 3 givenname: Pedro surname: Serrano fullname: Serrano, Pedro – sequence: 4 givenname: Javier surname: Fuentes fullname: Fuentes, Javier – sequence: 5 givenname: Sofía surname: Carreño fullname: Carreño, Sofía – sequence: 6 givenname: Jesusa surname: Guardia fullname: Guardia, Jesusa – sequence: 7 givenname: Mercedes surname: Sanz fullname: Sanz, Mercedes – sequence: 8 givenname: Miguel surname: Montoro fullname: Montoro, Miguel – sequence: 9 givenname: Ricardo surname: Sáinz fullname: Sáinz, Ricardo |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1501669$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/10995862$$D View this record in MEDLINE/PubMed |
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| CODEN | NEJMAG |
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| Keywords | 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 |
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| Snippet | Nonsteroidal antiinflammatory drugs, including low-dose aspirin, induce gastrointestinal complications.
1
–
3
Although new and potentially safer nonsteroidal... BACKGROUND The relation between medications that release nitric oxide, such as nitroglycerin and other nitrovasodilators, and upper gastrointestinal bleeding... Background The relation between medications that release nitric oxide, such as nitroglycerin and other nitrovasodilators, and upper gastrointestinal bleeding... The relation between medications that release nitric oxide, such as nitroglycerin and other nitrovasodilators, and upper gastrointestinal bleeding is... |
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| Title | Nitrovasodilators, Low-Dose Aspirin, Other Nonsteroidal Antiinflammatory Drugs, and the Risk of Upper Gastrointestinal Bleeding |
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