Combined NSAID, Antiplatelet Therapy: What's the Risk for GI Bleed?

the MPR take:

Research published in the journal Gastrointestinal Endoscopy investigates the effects of combined antithrombotic agents on lower GI bleeding (LGIB). 319 patients with LGIB and 3358 patients without GI bleeding were analyzed in the study; the primary outcome was odd ratios (ORs) for risk of LGIB associated with drug exposure. Main results of the study included the following: 

  • Single-use of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) or COX-2 inhibitors was independently linked to LGIB
  • NSAIDS + low-dose aspirin (OR 4.3) or NSAIDs + other antiplatelets (OR 4.9) were more likely to be associated with LGIB than NSAIDs alone (OR 2.3) 
  • Low-dose aspirin + thienopyridine (OR 2.2) or low-dose aspirin + other antiplatelets (OR 3.6) was associated with LGIB 
  • No significant association to LGIB was seen with low-dose aspirin, thienopyridine, or other antiplatelet monotherapy 
  • Combined use of multiple NSAIDs (OR 4.9) was associated with a greater risk in LGIB compared to single use (OR 2.3)

Combined NSAID, Antiplatelet Therapy: What's the Risk for GI Bleed?
Combined NSAID, Antiplatelet Therapy: What's the Risk for GI Bleed?

Background: The effect of a combined antithrombotic drug regimen on lower GI bleeding (LGIB) remains unknown. Objective: To investigate the risk of LGIB associated with nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin, thienopyridine (ticlopidine or clopidogrel), or other antiplatelets used.

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