Anti-inflammatory drugs and variceal bleeding: a case-control study

Background-Non-steroidal anti-inflammatory drugs (NSAIDs) can have severe g astrointestinal effects and cause peptic ulcers to bleed. Acute bleeding fr om oesophageal varices is a major complication of cirrhosis of the liver. Aims-To investigate the role, using a case-control study, of NSAIDs in firs t bleeding episodes associated with oesophageal or cardial varices in cirrh otic patients. Patients/Methods-A structured interview was conducted of 125 cirrhotic pati ents with bleeding mainly related to oesophageal varices and 75 cirrhotic c ontrols with oesophageal varices who had never bled. Results-Cirrhotic patients who were admitted for bleeding related to portal hypertension were more likely to have used NSAIDs during the week before t he index day (31 of 125 (25%)) than the cirrhotic controls (eight of 75 (11 %); odds ratio = 2.8, p = 0.016). Use of aspirin alone or combined with oth er NSAIDs was also more prevalent in the cases (21 of 125 (17%)) than in th e controls (three of 75 (4%); odds ratio = 4.9, p = 0.007). Logistic regres sion analysis showed that NSAID use (p = 0.022, odds ratio = 2.9, 95% confi dence interval = 1.8 to 4.7) and variceal size (p<0.001, odds ratio = 4.0, 95% confidence interval = 1.4 to 11.5) were the only variables independentl y associated with the risk of bleeding. Conclusions-Aspirin, used alone or combined with other NSAIDs, was associat ed with a first variceal bleeding episode in patients with cirrhosis. Given the life threatening nature of this complication, the possible benefit of this treatment should be weighed against the risk shown here. No firm concl usions could be drawn on non-aspirin NSAIDs used alone.