title: Time-trends in the prescribing of gastroprotective agents to primary care patients initiating low-dose aspirin or non-steroidal anti-inflammatory drugs: a population-based cohort study.
abstract: OBJECTIVE
  Low-dose aspirin (LDA) and non-steroidal-anti-inflammatory drugs (NSAIDs) both increase the risk of upper gastrointestinal events (UGIEs). In the Netherlands, recommendations regarding the prescription of gastroprotective agents (GPAs) in LDA users were first issued in 2009 in the HARM-Wrestling consensus. National guidelines on gastroprotective strategies (GPSs) in NSAID users were issued in the first part of the preceding. The aim of the present study was to examine time-trends in GPSs in patients initiating LDA and those initiating NSAIDs between 2000 and 2012.
  
  
  METHODS
  Within a large electronic primary healthcare database, two cohorts were selected: (i) patients newly prescribed LDA and (ii) patients newly prescribed NSAIDs between 2000 and 2012. Patients who had been prescribed a GPA in the previous six months were excluded. For both cohorts, patients' risk of a UGIE was classified as low, moderate or high, based on the HARM-Wrestling consensus, and the presence of an adequate GPSwas determined.
  
  
  RESULTS
  A total of 37 578 patients were included in the LDA cohort and 352 025 patients in the NSAID cohort. In both cohorts, an increase in GPSs was observed over time, but prescription of GPAs was lower in the LDA cohort. By 2012, an adequate GPS was present in 31.8% of high-risk LDA initiators, vs. 48.0% of high-risk NSAID initiators.
  
  
  CONCLUSIONS
  Despite a comparable risk of UGIEs, GPSs are prescribed less in high-risk LDA initiators than in high-risk NSAID initiators. For both groups of patients, there is still room for improvement in guideline adherence.
authors.affiliation: Radboud University medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
authors.forename: Margaretha F
authors.initials: MF
authors.lastname: Warlé-van Herwaarden
authors.affiliation: Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Aafke R
authors.initials: AR
authors.lastname: Koffeman
authors.affiliation: Department of Medical Informatics, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Vera E
authors.initials: VE
authors.lastname: Valkhoff
authors.affiliation: Department of Medical Informatics, Erasmus MC University Medical Center, Rotterdam, the Netherlands.|Children's Hospital Research Institute of Manitoba, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Geert W
authors.initials: GW
authors.lastname: 't Jong
authors.affiliation: Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Cornelis
authors.initials: C
authors.lastname: Kramers
authors.affiliation: Department of Medical Informatics, Erasmus MC University Medical Center, Rotterdam, the Netherlands.|Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Miriam C
authors.initials: MC
authors.lastname: Sturkenboom
authors.affiliation: Radboud University medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.|Department of Clinical Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Peter A G M
authors.initials: PA
authors.lastname: De Smet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000517:prevention & control*; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010437:Peptic Ulcer / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors; D001241:Aspirin
keywords: NSAIDs; gastrointestinal hemorrhages; gastroprotective agents; low-dose aspirin; pharmacoepidemiology