Hospitalization for gastrointestinal adverse events attributable to the use of low-dose aspirin among patients 50 years or older also using non-steroidal anti-inflammatory drugs: a retrospective cohort study.
BACKGROUND
Use of aspirin with non-steroidal anti-inflammatory drugs increases the risk of gastrointestinal ulcers; however, it is not clear if this risk varies with the non-steroidal anti-inflammatory drug used.


OBJECTIVE
To assess the risk of gastrointestinal hospitalizations attributable to aspirin in patients 50 years or older also using non-steroidal anti-inflammatory drugs.


METHODS
Administrative data of patients 50 years or older who received a non-steroidal anti-inflammatory drug or acetaminophen prescription between 1998 and 2004 were used.


RESULTS
Study patients received 7,412,992 non-steroidal anti-inflammatory drug prescriptions and 5,614,044 acetaminophen prescriptions among which 23% and 32%, respectively, were dispensed to aspirin users. Time-dependent Cox regression models revealed that, compared to patients using acetaminophen (without aspirin), the adjusted hazard ratio (95% CI) among non-users of aspirin were: rofecoxib 1.3 (1.2, 1.5), celecoxib 0.7 (0.6, 0.8), diclofenac 1.5 (1.2, 1.7), ibuprofen 0.9 (0.6, 1.4), naproxen 2.5 (2.1, 3.0) and piroxicam 1.5 (0.8, 2.8); among users of aspirin: rofecoxib 3.2 (2.8, 3.7), celecoxib 1.8 (1.5, 2.1), diclofenac 2.8 (2.2, 3.5), ibuprofen 1.4 (0.8, 2.7), naproxen 2.2 (1.6, 3.0) and piroxicam 2.0 (0.8, 5.4). The risk attributable to aspirin varied from none with naproxen to 61% (53%, 68%) with celecoxib.


CONCLUSIONS
The increase in gastrointestinal hospitalization attributable to aspirin differed with the non-steroidal anti-inflammatory drug used, and seemed higher with cyclo-oxygenase-2 inhibitors than with non-selective non-steroidal anti-inflammatory drugs.
Rahme
E
E
Department of Medicine, McGill University, Montreal, Canada. elham.rahme@mcgill.ca
Nedjar
H
H
Bizzi
A
A
Morin
S
S
D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000494:pharmacology; D001241:Aspirin / Q000009:adverse effects* / Q000494:pharmacology; D015331:Cohort Studies; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects* / Q000494:pharmacology; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D001241:Aspirin