TY - JOUR
T1 - Only full adherence to proton pump inhibitors protects against drug-induced upper gastrointestinal bleeding
AU - Ruiz, Borja
AU - Aguirre, Urko
AU - Estany-Gestal, Ana
AU - Rodella, Luca
AU - Ruiz, Pablo
AU - Figueiras, Adolfo
AU - Carvajal, Alfonso
AU - Ibáñez, Luisa
AU - Conforti, Anita
AU - de Pancorbo, Marian M.
AU - Vidal, Xavier
AU - Martin, Luis H.
AU - Aguirre, Carmelo
PY - 2018/11/1
Y1 - 2018/11/1
N2 - © 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: The use of gastroprotective agents has allowed significant progress in the prevention of upper gastrointestinal bleeding (UGIB) associated with non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelet agents. Nevertheless, some concerns remain regarding the gastroprotective dosage and treatment duration. Our aim was to study the effect of gastroprotective agents in UGIB induced by NSAIDs and single- or dual-antiplatelet therapy. Methods: A multicenter case-control study was conducted including 577 cases diagnosed with UGIB and 1343 sex-, age-, and hospital-matched controls. To estimate exposure to NSAIDs and gastroprotective agents, consumption was calculated for the 4 weeks prior to hospital admission in terms of defined daily doses (DDDs). Risk groups for UGIB induced by NSAIDs and single- or dual-antiplatelet therapy were defined as a function of each drug dose, use of gastrointestine-damaging drugs, and risk factors for UGIB. Odds ratios (ORs) with 95% confidence intervals (CIs) were adjusted for single- (model 1) and dual- (model 2) antiplatelet therapy. Results: Full adherence (> 0.80DDD) to proton pump inhibitors (PPIs) was the only gastroprotective therapy that significantly reduced the risk of UGIB, considering NSAID risk (OR: 0.53; 95% CI: 0.30–0.95) and dose (OR: 0.48; 95% CI: 0.27–0.87) with ORs adjusted for single-antiplatelet therapy (model 1) and NSAID risk (OR: 0.55; 95% CI: 0.31–0.98) and dose (OR: 0.49; 95% CI: 0.28–0.89) with ORs adjusted for dual-antiplatelet therapy (model 2). Conclusions: These results reinforce the recommendation of adding a PPI at effective doses (full adherence) to prevent UGIB induced by NSAIDs, or single- or dual-antiplatelet therapy.
AB - © 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: The use of gastroprotective agents has allowed significant progress in the prevention of upper gastrointestinal bleeding (UGIB) associated with non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelet agents. Nevertheless, some concerns remain regarding the gastroprotective dosage and treatment duration. Our aim was to study the effect of gastroprotective agents in UGIB induced by NSAIDs and single- or dual-antiplatelet therapy. Methods: A multicenter case-control study was conducted including 577 cases diagnosed with UGIB and 1343 sex-, age-, and hospital-matched controls. To estimate exposure to NSAIDs and gastroprotective agents, consumption was calculated for the 4 weeks prior to hospital admission in terms of defined daily doses (DDDs). Risk groups for UGIB induced by NSAIDs and single- or dual-antiplatelet therapy were defined as a function of each drug dose, use of gastrointestine-damaging drugs, and risk factors for UGIB. Odds ratios (ORs) with 95% confidence intervals (CIs) were adjusted for single- (model 1) and dual- (model 2) antiplatelet therapy. Results: Full adherence (> 0.80DDD) to proton pump inhibitors (PPIs) was the only gastroprotective therapy that significantly reduced the risk of UGIB, considering NSAID risk (OR: 0.53; 95% CI: 0.30–0.95) and dose (OR: 0.48; 95% CI: 0.27–0.87) with ORs adjusted for single-antiplatelet therapy (model 1) and NSAID risk (OR: 0.55; 95% CI: 0.31–0.98) and dose (OR: 0.49; 95% CI: 0.28–0.89) with ORs adjusted for dual-antiplatelet therapy (model 2). Conclusions: These results reinforce the recommendation of adding a PPI at effective doses (full adherence) to prevent UGIB induced by NSAIDs, or single- or dual-antiplatelet therapy.
KW - Acid-suppression therapy
KW - Hemorrhage
KW - Prospective case-control
KW - Upper gastrointestinal
U2 - 10.1007/s00228-018-2523-4
DO - 10.1007/s00228-018-2523-4
M3 - Article
C2 - 30043109
VL - 74
SP - 1503
EP - 1511
JO - European Journal of Clinical Pharmacology
JF - European Journal of Clinical Pharmacology
SN - 0031-6970
ER -