title: Risk factors associated with NSAID-induced upper gastrointestinal bleeding resulting in hospital admissions: A cross-sectional, retrospective, case series analysis in valencia, spain.
abstract: Abstract.
  
  
  BACKGROUND
  NSAIDs are a significant cause of drug-related hospital admissions and deaths. The therapeutic effects of NSAIDs have been associated with the risk for developing adverse events, mainly in the gastrointestinal tract.
  
  
  OBJECTIVE
  The focus of this study was to identify the most common risk factors associated with NSAID-induced upper gastrointestinal bleeding (UGIB) resulting in hospital admissions. A secondary end point was the relationship between use of gastroprotective treatment and relevant risk factors to NSAID-induced UGIB in the selected population.
  
  
  METHODS
  This study was a cross-sectional, retrospective, case-series analysis of NSAID-induced UGIB resulting in hospital admission to the Requena General Hospital, Valencia, Spain, occurring from 1997 to 2005. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify UGIB admissions associated with NSAIDs. To estimate the probability of association between UGIB and the use of NSAIDs, the Naranjo adverse drug reaction probability was used. Patients were categorized as high-risk to develop UGIB if they met ≥1 of the following risk criteria (relevant risk factors): aged ≥65 years (age risk factor); peptic ulcer disease or NSAID gastropathy occurring in the year before their hospital admission (history risk factor); and concomitant use of other NSAIDs, systemic corticoids, oral anticoagulants, or platelet aggregation inhibitors (concomitant medication risk factor). Patients were categorized as candidates to use gastroprotections if they met ≥1 of the relevant risk factors. Patients were categorized as users of gastroprotective treatment if they used proton pump inhibitors, histamine H2-receptor antagonists, or misoprostol at hospital admission.
  
  
  RESULTS
  This study comprised 209 cases of NSAID-induced UGIB (129 men, 80 women: mean [SD] age, 71.5 [13.8] years; 128 [61.2%] receiving acetyl salicylic acid [ASA], with 72 [34.4%] receiving low-dose [80-325 mg] ASA). Prevalence of relevant risk factors for UGIB were as follows: age, 158 (75.6%) patients; history, 37 (17.7%); and concomitant medication, 35 (16.7%). One hundred seventy-eight (85.2%) patients met ≥1 criterion for using a gastroprotective agent; 28 (15.6%) were actually using one. Only the history risk factor was significantly associated with the use of gastroprotective treatment (P = 0.007; odds ratio = 3.17).
  
  
  CONCLUSIONS
  In this study of NSAID-induced UGIB resulting in hospital admission, age was the most common risk factor. However, this criterion was not associated with the use of gastroprotective agents. A large number of cases were associated with the use of ASA, primarily in those receiving low doses. A significant lack of gastroprotective agent use was observed in patients who met the criteria to use them.
authors.affiliation: Pharmacy Service, Requena General Hospital, Valencia, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Marco
authors.affiliation: Faculty of Pharmaceutical Chemistry, University of Antioquia, Medellin, Colombia ; Research Group on Pharmaceutical Care, University of Granada, Granada, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Amariles
authors.affiliation: Emergency Department, Requena General Hospital, Valencia, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Boscá
authors.affiliation: Community Pharmacist, Valencia in Tavernes de la Valldigna, Valencia, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Castelló
keywords: elderly; hospital admissions; nonsteroidal anti-inflammatory drugs; risk factors; upper gastrointestinal bleeding