NSAIDs and Upper GI Bleed
NSAIDs and Upper GI Bleed
- Stomach and platelets have much more COX-1 receptors than COX-2 receptors.
- Below are statistics from a systematic review on NSAIDs and upper GI complications (bleeding, perforation)
Ketorolac
- Has the highest relative risk for upper GI complication = 14.54 (see below)
- Before giving, first check that patients do NOT have a history of a GI bleed or peptic ulcer disease.
NSAID-Induced Complications
| NSAID Medication | Estimated Relative Risk of Complication | [95 % CI] |
|---|---|---|
| COX-1 Inhibitors (all) | 4.5 | [3.82-5.31] |
| - Ibuprofen | 2.69 | [2.17-3.33] |
| - Diclofenac | 3.98 | [3.36-4.72] |
| - Meloxicam | 4.15 | [2.59-6.64] |
| - Indomethacin | 5.40 | [4.16-7.00] |
| - Ketoprofen | 5.57 | [3.94-7.87] |
| - Naproxen | 5.63 | [3.83-8.28] |
| - Piroxicam | 9.94 | [5.99-16.50] |
| - Ketorolac | 14.54 | [5.87-36.04] |
| COX-2 Inhibitors (all) | 1.88 | [0.96-3.71] |
| - Celecoxib | 1.42 | [0.85-2.37] |
| - Aceclofenac | 1.44 | [0.65-3.2] |
| - Rofecoxib | 2.12 | [1.59-2.84] |
Risk Factors for Upper GI Complication
- Longer drug half-life
- Slow-release formulation
- Dual inhibition of COX-1 and COX-2 isoenzymes
Relative risk is greatest when first starting medication (<30 days)
References
- Massó González EL, Patrignani P, Tacconelli S, García Rodríguez LA. Variability among nonsteroidal antiinflammatory drugs in risk of upper gastrointestinal bleeding. Arthritis Rheum. 2010 Jun;62(6):1592-601 [PubMed]
