title: Burden of nonsteroidal anti-inflammatory and antiplatelet drug use in Asia: a multidisciplinary working party report.
abstract: OBJECTIVE
  We established a working group to examine the burden of atherothrombotic and musculoskeletal diseases in Asia and made recommendations for safer prescribing of nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin.
  
  
  METHODS
  By using a modified Delphi process, consensus was reached among 12 multidisciplinary experts from Asia. Statements were developed by the steering committee after a literature review, modified, and then approved through 3 rounds of anonymous voting by using a 6-point scale from A+ (strongly agree) to D+ (strongly disagree). Agreement (A+/A) by ≥ 80% of panelists was defined a priori as consensus.
  
  
  RESULTS
  We identified unique aspects of atherothrombotic and musculoskeletal diseases in Asia. Asia has a lower prevalence of degenerative arthritis and coronary artery disease than Western countries. The age-adjusted mortality of coronary artery disease is lower in Asia; cerebrovascular accident has higher mortality than coronary artery disease. Ischemia has replaced hemorrhage as the predominant pattern of cerebrovascular accident. Low-dose aspirin use is less prevalent in Asia than in Western countries. Traditional Chinese medicine and mucoprotective agents are commonly used in Asia, but their efficacy is not established. For Asian populations, little is known about complications of the lower gastrointestinal tract from use of NSAIDs and underutilization of gastroprotective agents. Our recommendations for preventing ulcer bleeding among users of these drugs who are at high risk for these complications were largely derived from Asian studies and are similar to Western guidelines.
  
  
  CONCLUSIONS
  By using an evidence-based, multidisciplinary approach, we have identified unique aspects of musculoskeletal and atherothrombotic diseases and strategies for preventing NSAID-related and low-dose aspirin-related gastrointestinal toxicity in Asia.
authors.affiliation: Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong. fklchan@cuhk.edu.hk
authors.forename: Francis Ka-Leung
authors.initials: FK
authors.lastname: Chan
authors.forename: Shinya
authors.initials: S
authors.lastname: Goto
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
authors.forename: Maria Teresa B
authors.initials: MT
authors.lastname: Abola
authors.forename: Khay Guan
authors.initials: KG
authors.lastname: Yeoh
authors.forename: Bambang
authors.initials: B
authors.lastname: Sutrisna
authors.forename: Siew Siang
authors.initials: SS
authors.lastname: Chua
authors.forename: Varocha
authors.initials: V
authors.lastname: Mahachai
authors.forename: Thana
authors.initials: T
authors.lastname: Turajane
authors.forename: Brian
authors.initials: B
authors.lastname: Wu
authors.forename: Qing Yu
authors.initials: QY
authors.lastname: Zeng
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugano
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001208:Asia / Q000453:epidemiology; D050197:Atherosclerosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006801:Humans; D009140:Musculoskeletal Diseases / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015995:Prevalence
chemical_list: D000893:Anti-Inflammatory Agents; D010975:Platelet Aggregation Inhibitors