Table 4.
Anti-inflammatory drug use in individuals with UGIB and controls with no UGIB, and its association with a diagnosis of UGIB, in a cohort of low-dose ASA users.
| Controls N = 2000 | UGIB Cases N = 169 | RR (95% CI)* | |||
|---|---|---|---|---|---|
| n | % | n | % | ||
| NSAIDs | |||||
| Non-use | 1607 | 80.3 | 116 | 68.6 | 1 (–) |
| Current use | 156 | 7.8 | 28 | 16.6 | 2.66 (1.66–4.26) |
| Single NSAID | 143 | 7.1 | 24 | 14.2 | 2.50 (1.52–4.11) |
| Multiple NSAIDs | 13 | 0.7 | 4 | 2.4 | 4.41 (1.33–14.63) |
| Past use | 237 | 11.8 | 25 | 14.8 | 1.39 (0.86–2.26) |
| DURATION OF NSAID USE† | |||||
| ≤30 days | 33 | 1.7 | 8 | 4.7 | 3.49 (1.49–8.18) |
| 31–365 days | 64 | 3.2 | 9 | 5.3 | 2.07 (0.97–4.42) |
| >1 year | 46 | 2.3 | 7 | 4.1 | 2.35 (1.00–5.57) |
| NSAID DOSE† | |||||
| Low–medium | 65 | 3.2 | 13 | 7.7 | 3.13 (1.61–6.06) |
| High | 65 | 3.2 | 10 | 5.9 | 2.10 (1.01–4.34) |
| Unknown | 13 | 0.6 | 1 | 0.6 | 1.49 (0.19–11.73) |
| INTERACTION WITH NSAIDs | |||||
| ASA without NSAID | 1260 | 63.0 | 92 | 54.4 | 1 (–) |
| ASA plus NSAID | 133 | 6.7 | 26 | 15.4 | 2.92 (1.77–4.82) |
| ORAL CORTICOSTEROIDS | |||||
| Non-use | 1891 | 94.6 | 159 | 94.1 | 1 (–) |
| Current use (0–30 days) | 60 | 3.0 | 5 | 3.0 | 0.88 (0.33–2.31) |
| Past use (31–365 days) | 49 | 2.4 | 5 | 3.0 | 0.97 (0.36–2.62) |
*Adjusted by sex, age, follow-up time, history of peptic ulcer disease, number of PCP visits, referrals and hospitalizations, and use of warfarin, ASA, clopidogrel, NSAIDs, and PPIs.
†Duration and dose–response was evaluated among current single NSAID users. Reference group for duration and dose–response was non-use. Specific cut-off values for dose (in mg) were as follows: aceclofenac 200, acemetacin 120, azapropazone 600, celecoxib 200, diclofenac 100, diflunisal 1500, etodolac 400, etoricoxib 90, fenbufen 900, fenoprofen 1200, flurbiprofen 150, ibuprofen 1200, indomethacin 75, ketoprofen 150, ketorolac 30, mefenamic acid 1000, meloxicam 7.5, nabumetone 1000, naproxen 750, piroxicam 10, rofecoxib 25, sulindac 200, tenoxicam 10, tiaprofenic 600, and valdecoxib 20. Doses less than or equal to the cut-off value were grouped under low–medium doses, and doses greater than the cut-off value were grouped under high doses.
Note: Data on PCP visits, number of referrals and number of hospitalizations were collected for the year prior to the index date. Data on comorbidity was collected for any time before the start date.
ASA, acetylsalicylic acid; CI, confidence interval; NSAID, non-steroidal anti-inflammatory drug; OTC, over-the-counter; PCP, primary care practitioner; PPI, proton pump inhibitor; PU, peptic ulcer; RR, relative risk; UGIB, upper gastrointestinal bleeding.