Recent nonsteroidal anti-inflammatory drug use increases the risk of earlyrecurrence of bleeding in patients presenting with bleeding ulcer

Background: Nonsteroidal anti-inflammatory drug (NSAID) use is a well-known risk factor for ulcer formation and ulcer complications. The purpose of th is study was to determine whether recent NSAID use increases the risk of ea rly recurrence of bleeding in patients who present with bleeding ulcer. Methods: Clinical and endoscopic data were collected prospectively, Dose, f requency, and duration of recent NSAID use were quantified. Recent NSAID us e was defined as consumption of over-the-counter or prescription NSAIDs or aspirin for at least 5 days of the 2-week period preceding the index episod e of bleeding. Endoscopy was performed within 24 hours of admission to conf irm the source of bleeding and endoscopic intervention was applied for stig mata of bleeding. Early recurrence of bleeding was defined as melena, hemat ochezia or blood per nasogastric tube with a 2 gm or greater decrease in he moglobin during a period of 48 hours, occurring less than 2 weeks from inde x episode of bleeding. Results: One hundred twenty patients (52 NSAID users and 68 nonusers) were enrolled in the study; mean age was 56 years. NSAID users were older than n onusers (p = 0.003); nonusers were more likely to have a history of ulcer d isease (p < 0.0005) and higher prevalence of Helicobacter pylori infection (p = 0.05). Recent NSAID use was associated with a significantly higher fre quency of early recurrence of bleeding and in-hospital recurrent bleeding c ompared with nonusers: 19% vs. 6%, p = 0.02, and 17% vs. 6%, p = 0.04, resp ectively. In multivariate logistic regression analysis, the significant ass ociation between recent NSAID use and early recurrence of bleeding persiste d (p = 0.0048) while controlling for age and other covariates, Conclusions: Recent NSAID use predisposes bleeding ulcer patients to early and in-hospital recurrent bleeding, probably via its effects on platelet fu nction, mucosal prostaglandins, and ulcer healing.