title: Lower GI bleeding risk of nonsteroidal anti-inflammatory drugs and antiplatelet drug use alone and the effect of combined therapy.
abstract: BACKGROUND
  The effect of a combined antithrombotic drug regimen on lower GI bleeding (LGIB) remains unknown.
  
  
  OBJECTIVE
  To investigate the risk of LGIB associated with nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin, thienopyridine (ticlopidine or clopidogrel), or other antiplatelets used.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Emergency hospital, gastroenterology department.
  
  
  METHODS
  A cohort of 319 patients emergently hospitalized for acute, continuous, or frequent LGIB and 3358 patients with no bleeding on colonoscopy.
  
  
  METHODS
  Odds ratios (ORs) for the risk of LGIB associated with drug exposure adjusting for age, sex, smoking, alcohol, medications, comorbidities, and GI symptom scores.
  
  
  RESULTS
  After considering antithrombotic drugs by dividing them into single- and combined-use, single use of nonselective NSAID or cyclooxygenase-2 inhibitor was independently associated with LGIB. The combined use of NSAIDs with low-dose aspirin (OR 4.3) or with other antiplatelets (OR 4.9) was more associated with LGIB than the use of NSAIDs alone (OR 2.3). Use of low-dose aspirin, thienopyridine, or other antiplatelets alone was not significantly associated with LGIB, but combined use of low-dose aspirin with thienopyridine (OR 2.2) or with other antiplatelets (OR 3.6) was associated with LGIB. Combined use of different NSAIDs carried a higher risk than single use (combined use, OR 4.9; single use, OR 2.3).
  
  
  CONCLUSIONS
  Single-center study.
  
  
  CONCLUSIONS
  The use of nonselective or selective NSAIDs alone was associated with LGIB. Although antiplatelet use alone was not significantly associated with LGIB, combined use of NSAIDs with antiplatelets or of low-dose aspirin with thienopyridine or with nonthienopyridine antiplatelets was independently associated with LGIB.
authors.affiliation: Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Nagata
authors.affiliation: Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Niikura
authors.affiliation: Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Aoki
authors.affiliation: Department of Clinical Research and Informatics, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.affiliation: Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kishida
authors.affiliation: Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Sekine
authors.affiliation: Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Okubo
authors.affiliation: Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sakurai
authors.affiliation: Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Chizu
authors.initials: C
authors.lastname: Yokoi
authors.affiliation: Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.affiliation: Department of Gastroenterology and Hepatology, International Clinical Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Yanase
authors.affiliation: Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizokami
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D000077144:Clopidogrel; D003108:Colonic Diseases / Q000150:complications; D003113:Colonoscopy; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D011446:Prospective Studies; D012002:Rectal Diseases / Q000150:complications; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin