Upper gastrointestinal bleeding among users of NSAIDS: a population-based cohort study in Denmark
Upper gastrointestinal bleeding among users of NSAIDS: a population-based cohort study in Denmark
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DOI：
10.1046/j.0306-5251.2001.01220.x
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发表时间：
2002-02-01
影响因子：
3.4
通讯作者：
Olsen, JH
中科院分区：
文献类型：
--
作者：
Mellemkjaer, L;Blot, WJ;Olsen, JH
目的众所周知，使用非甾体抗炎药（NSAIDs）会增加上消化道出血（UGIB）的风险，但在人群水平上，过量风险的关联特征和量化需要澄清。方法对1991- 1995年丹麦北日德兰县所有非阿司匹林处方非甾体抗炎药使用者进行调查。使用出院登记簿，在156 138名非甾体抗炎药使用者中确定所有ugib住院情况，并与未接受非甾体抗炎药处方的北日德兰人口的预期人数进行比较。在使用非甾体抗炎药而不使用其他与UGIB相关的药物期间，我们观察到365例UGIB，比预期的数字高出3.6倍（95% CI = 3.3）。4.0)。过量风险因非甾体抗炎药的性别、类型、形式和给药途径而异，但不受首次服用非甾体抗炎药的年龄或既往处方数量的影响。停止使用后风险急剧下降。对于布洛芬和萘普生，尽管最低剂量也与UGIB过量有关，但随着剂量的增加，风险有明显上升的趋势。同时使用皮质类固醇、抗凝血剂和阿司匹林进一步增加了UGIB的风险。结论所有类型和剂型的非甾体抗炎药均可增加ugib的发生风险，但其影响不具有累积性，且随停药而迅速降低。在北日德兰郡的所有人口中，高达15%的ugib可能是由使用这种药物引起的。
Aims It is well-known that use of nonsteroidal anti-inflammatory drugs (NSAIDs) increases the risk of upper gastrointestinal bleeding (UGIB), but characteristics of the association and quantification of excess risk at the population level require clarification.Methods All users of nonaspirin prescription NSAIDs in North Jutland County, Denmark during 1991-95 were identified in the regional Pharmaco-Epidemiologic Database. Using the Hospital Discharge Register, all hospitalizations for UGIBs were identified among the 156 138 users of NSAIDs and compared with the number of expected based on the North Jutland population who did not receive NSAID prescriptions.Results During periods of NSAID use without use of other drugs associated with UGIB, we observed 365 UGIBs, a number 3.6 times higher than expected (95% CI = 3.3. 4.0). The excess risk varied by sex, type of NSAID and form and route of administration of the NSAID, but not by age at first NSAID prescription or number of prior prescriptions. Risk declined sharply following cessation of use. For ibuprofen and naproxen, there was a clear trend in rising risk by increasing dose, although the lowest doses were also associated with an excess of UGIB. Concurrent use of corticosteroids, anticoagulants and aspirin further increased the risk of UGIB.Conclusions All types and formulations of NSAIDs appear to increase the risk of UGIBs, but the effect appear not to be cumulative and diminish rapidly with discontinue of use. Up to 15% of the UGIBs in the entire population of the North Jutland County may be explained by use of this drug.