title: Implication of antithrombotic agents on potential bleeding from endoscopically determined peptic ulcers, incidentally detected as surrogate markers for nsaids-associated ulcers complication.
abstract: OBJECTIVE
  Little is known about the clinical significance of treatment for endoscopically determined peptic ulcers (EPU), incidentally detected as surrogate endpoints for non-steroidal anti-inflammatory drugs (NSAIDs)-associated ulcers complication, such as overt bleeding and perforation. Even uncomplicated-EPU without overt bleeding signs when antithrombotic agents (AT) were cotherapied may be of potential bleeding sites. The aim of the present study was to evaluate whether microcytic anemia, implying potential bleeding, is associated with NSAIDs-associated EPU or cotherapies with AT.
  
  
  METHODS
  Two hundred and thirty-eight outpatients with rheumatoid arthritis under long-term NSAIDs therapies underwent upper endoscopy and were divided into the following four groups according to the pattern (presence: + or absence: -) of AT cotherapy/EPU, respectively: A, -/- (n = 165); B, -/+ (n = 44); C, +/- (n = 25); and D, +/+ (n = 4).
  
  
  RESULTS
  EPU were found in 48 of the 238 studied patients (20.2%). After significant interactions among four groups hadstatistically been identified, hemoglobin (Hb) and mean corpuscular volume (MCV) as biomarkers for potential bleeding were compared between the groups.Hb and MCV were significantly lower in the D group than in the A,B, or C groups (Hb: P < 0.01, respectively; P < 0.05, MCV; P < 0.01 or P < 0.05, respectively).
  
  
  CONCLUSIONS
  Patients with NSAIDs-associated EPU and AT cotherapy indicated significantly more severe microcytic anemia pattern than those without EPU or AT cotherapy, despite no evidence of overt bleeding. Even uncomplicated-EPU without overt bleeding when ATs were cotherapied may be of potential bleeding sites.
authors.affiliation: Department of Gastroenterology, Nippon Medical School, Tokyo, Japan. km366@nms.ac.jp
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Miyake
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kusunoki
authors.forename: Nobue
authors.initials: N
authors.lastname: Ueki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nagoya
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodaka
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Shindo
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kawagoe
authors.forename: Katya
authors.initials: K
authors.lastname: Gudis
authors.forename: Seiji
authors.initials: S
authors.lastname: Futagami
authors.forename: Taku
authors.initials: T
authors.lastname: Tsukui
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakamura
authors.forename: Choitsu
authors.initials: C
authors.lastname: Sakamoto
mesh_terms: D000704:Analysis of Variance; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000175:diagnosis; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000139:chemically induced / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005343:Fibrinolytic Agents