RISKS OF BLEEDING PEPTIC-ULCER ASSOCIATED WITH INDIVIDUAL NONSTEROIDAL ANTIINFLAMMATORY DRUGS

Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is assoc iated with an increased risk of peptic ulcer complications, but it is not clear whether some drugs are more likely than others to cause such complications. We compared previous use of NSAIDs in 1144 patients ag ed 60 and older admitted to hospitals in five large cities with peptic ulcer bleeding and in 1126 hospital controls and 989 community contro ls matched for age and sex. Peptic ulcer bleeding was strongly associa ted with use of non-aspirin NSAIDs of any type during the 3 months bef ore admission (411 cases, 351 controls; odds ratio 4.5 [95% Cl 3.6 to 5.6]). The odds ratios for peptic ulcer bleeding were lowest for ibupr ofen (2.0 [1.4-2.8]) and diclofenac (4.2 [2.6-6.8]), and intermediate for indomethacin, naproxen, and piroxicam (11.3 [6.3-20.3], 9.1 [5.5-1 5.1], and 13.7 [7.1-26.3]). Azapropazone and ketoprofen carried the hi ghest risks (31.5 [10.3-96.9] and 23.7 [7.6-74.2]). Risks also increas ed with drug dose (low dose 2.5 [1.7-3.8], intermediate 4.5 [3.3-6.0], and high 8.6 [5.8-12.6]) for all drugs combined. Appropriate clinical strategies could prevent many episodes of peptic ulcer bleeding: NSAI Ds should be used only in patients who do not respond to other analges ics; the lowest possible doses should be used; and the least toxic NSA IDs should be selected.