Premium
The use of prophylactic gastroprotective therapy in patients with nonsteroidal anti‐inflammatory drug‐ and aspirin‐associated ulcer bleeding: a cross‐sectional study
Author(s) -
Ho C. W.,
Tse Y. K.,
Wu B.,
Mulder C. J. J.,
Chan F. K. L.
Publication year - 2013
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12259
Subject(s) - medicine , aspirin , nonsteroidal , incidence (geometry) , medical prescription , drug , surgery , gastroenterology , pharmacology , physics , optics
Summary Background Poor adherence to gastroprotective agents ( GPA s) is common among users of nonsteroidal anti‐inflammatory drugs ( NSAID s) or low‐dose aspirin ( ASA ). There are little data on the utilization of GPA s among NSAID and ASA users complicated by ulcer bleeding. Aim To study the utilization of GPA among NSAID and ASA ulcers before the onset of ulcer bleeding. Methods We conducted a cross‐sectional study to determine the exposure to NSAID s, ASA , and GPA s within 4 weeks before endoscopically confirmed ulcer bleeding. Sensitivity analysis was performed to study how improving adherence to GPA use would reduce the risk of ulcer bleeding in high‐risk users. Results Between 2000 and 2009, 1093 and 2277 patients had NSAID ‐ and ASA ‐associated ulcer bleeding respectively. The incidence of NSAID ‐associated ulcer bleeding declined by 40%, whereas that of ASA ‐associated ulcer bleeding increased by 46%. Thirty‐nine per cent of NSAID users and 75% of ASA users belonged to high ulcer risk category. Although GPA prescription rate has increased over time, only 41.6% and 30.6% of high‐risk NSAID and ASA users received GPA s before ulcer bleeding respectively. Sensitivity analysis showed that if GPA s could reduce bleeding risk by 50%, improving adherence would prevent up to 35% of ulcer bleeding in high‐risk users. Conclusions A substantial proportion of high‐risk NSAID and ASA users had not received prophylaxis with gastroprotective agents before ulcer bleeding. These bleeding episodes may be preventable with better adherence to gastroprotective agent use.