ARE SYSTEMIC LEVELS OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS RELEVANT TO ACUTE UPPER GASTROINTESTINAL HEMORRHAGE

It is uncertain as to the extent which gastrointestinal (GI) haemorrha ge related to NSAIDs is due to a local, topical effect or to an action related to systemic absorption. We hypothesised that, should systemic drug concentrations be of importance, plasma levels of NSAIDs might b e higher in patients who had developed GI haemorrhage, from controls w ho had not. Ten patients with GI haemorrhage, who had ingested piroxic am (and no other NSAID), within the preceding 64 h, at the same dosage and on no new medication for the past 14 days, had blood taken at pre sentation for measurement of piroxicam concentrations. Plasma piroxica m concentrations were measured in 19 community dwelling controls, matc hed for age +/- 8 years, gender, daily piroxicam dosage, and time from last dose as their respective index case. All had been taking piroxic am for at least 3 months, and none had experienced GI adverse effects. Median plasma piroxicam concentrations in patients at 8.27 mug/l, was higher than in controls at 5.06 mug/l. These results suggest that a s ystemic component, at least with piroxicam, may play a significant (th ough not necessarily exclusive) role in causing major gastrointestinal haemorrhage.