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August 1, 2004JCR Journal of Clinical Rheumatology

Risk of Upper Gastrointestinal Injury and Events in Patients Treated With Cyclooxygenase (COX)-1/COX-2 Nonsteroidal Antiinflammatory Drugs (NSAIDs), COX-2 Selective NSAIDs, and Gastroprotective Cotherapy

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Why the study?

Does the use of COX-2 selective NSAIDs or gastroprotective cotherapy reduce the risk of gastrointestinal injury in patients taking NSAIDs or low-dose aspirin?

Population

Populations with varying risk characteristics using nonsteroidal antiinflammatory drugs and/or low-dose…

Comparison

Cyclooxygenase-2 selective NSAIDs and/or… vs Nonusers, traditional nonselective NSAIDs, or no…

Design

Review

Key result

Nonselective NSAIDs increased the relative risk of hospitalization for upper gastrointestinal bleeding compared with celecoxib (RR 4.4; 95% CI 2.3-8.5) and rofecoxib (RR 1.9; 95% CI 1.0-3.5).

Authors

RDRobert W. DuboisGMGil MelmedJHJames M. Henning

Discussion

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Overview

GI risk stratification with aspirin/NSAIDs remains imprecise; leaves open need for standardized studies to quantify factors.

Structured PICO

Does the use of COX-2 selective NSAIDs or gastroprotective cotherapy reduce the risk of gastrointestinal injury in patients taking NSAIDs or low-dose aspirin?

P
Population
Populations with varying risk characteristics using nonsteroidal antiinflammatory drugs (NSAIDs) and/or low-dose aspirin
E
Exposure
Cyclooxygenase-2 (COX-2) selective NSAIDs (celecoxib, rofecoxib) and/or gastroprotective cotherapy (proton pump inhibitors, misoprostol)
C
Comparator
Nonusers, traditional nonselective NSAIDs, or no gastroprotective cotherapy
O
Outcome
Incidence of gastrointestinal injury and gastrointestinal bleedingsafety

Main Result

Relative Risk: 4.4 (95% CI 2.3–8.5)

COX-2 selective inhibitors and gastroprotective cotherapy (proton pump inhibitors or misoprostol) significantly reduce the risk of upper gastrointestinal injury and bleeding in patients requiring NSAIDs, particularly those on concurrent low-dose cardioprotective aspirin.

Cite This Study

Dubois et al. (2004) conducted a review in Patients treated with NSAIDs. Nonselective NSAIDs vs. COX-2 selective inhibitors (celecoxib, rofecoxib) was evaluated on Hospitalization resulting from upper gastrointestinal bleeding (RR 4.4, 95% CI 2.3-8.5). Nonselective NSAIDs increased the relative risk of hospitalization for upper gastrointestinal bleeding compared with celecoxib (RR 4.4; 95% CI 2.3-8.5) and rofecoxib (RR 1.9; 95% CI 1.0-3.5).

synapsesocial.com/papers/6a6ae7401e51ef7293b3a88ahttps://doi.org/10.1097/01.rhu.0000128851.12010.46
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