title: Risk of upper gastrointestinal bleeding associated with non-aspirin cardiovascular drugs, analgesics and nonsteroidal anti-inflammatory drugs.
abstract: OBJECTIVE
  To evaluate the risk of upper gastrointestinal bleeding associated with non-aspirin cardiovascular drug therapy, common analgesics and individual nonsteroidal anti-inflammatory drugs (NSAIDs).
  
  
  METHODS
  The case group was made up of 1122 consecutive patients admitted with bleeding from a peptic lesion. The 2231 control subjects consisted of 1109 patients hospitalized for other reasons and 1122 outpatients from the same geographical area. The relative risk was calculated by unconditional logistic regression after adjusting for confounding factors.
  
  
  RESULTS
  The use of the antiplatelet agent triflusal, and other commonly used cardiovascular drugs, such as beta-receptor blockers and calcium channel blockers, was not associated with increased risk of upper gastrointestinal bleeding. The use of angiotensin-converting enzyme inhibitors reduced the risk of bleeding by 30% (odds ratio 0.7; 95% confidence interval 0.5-0.96). Use of ketorolac (odds ratio 59.4; 95% confidence interval 7.7-454) and piroxicam (odds ratio 19.6; 95% confidence interval 9.3-35.3) carried the highest risk. Use of paracetamol and tramadol was not associated with increased risk of bleeding, but the non-narcotic agent metamizol was associated with a small increase in risk of upper gastrointestinal bleeding (odds ratio 2.6; 95% confidence interval 1.3-5.2).
  
  
  CONCLUSIONS
  The use of the antiplatelet agent triflusal and other cardiovascular drugs apart from low-dose aspirin was not associated with gastrointestinal bleeding. The use of either NSAIDs or aspirin increased the risk of gastrointestinal bleeding but, among the analgesics, only metamizol induced a small increase in the risk of gastrointestinal bleeding.
authors.affiliation: Service of Gastroenterology, University Hospital Lozano Blesa, C/San Juan Bosco 15, 50009 Zaragoza, Spain. alanas@posta.unizar.es
authors.forename: Angel
authors.initials: A
authors.lastname: Lanas
authors.forename: Pedro
authors.initials: P
authors.lastname: Serrano
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bajador
authors.forename: Javier
authors.initials: J
authors.lastname: Fuentes
authors.forename: Ricardo
authors.initials: R
authors.lastname: Sáinz
mesh_terms: D000368:Aged; D000700:Analgesics / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002121:Calcium Channel Blockers / Q000009:adverse effects; D002317:Cardiovascular Agents / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000700:Analgesics; D000806:Angiotensin-Converting Enzyme Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D002121:Calcium Channel Blockers; D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors