Format

Send to

Choose Destination
Am J Gastroenterol. 2008 Nov;103(11):2908-18. doi: 10.1111/j.1572-0241.2008.02200.x. Epub 2008 Oct 1.

Management of patients on nonsteroidal anti-inflammatory drugs: a clinical practice recommendation from the First International Working Party on Gastrointestinal and Cardiovascular Effects of Nonsteroidal Anti-inflammatory Drugs and Anti-platelet Agents.

Author information

1
Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong.

Abstract

BACKGROUND:

Prescribing nonsteroidal antiinflammatory drugs (NSAIDs) is challenging because physicians have to consider gastrointestinal (GI) and cardiovascular (CV) safety issues.

OBJECTIVE:

The purpose of the study was to determine appropriate NSAID treatment strategies based on different combinations of GI and CV risks.

METHODS:

The working party comprised a multidisciplinary international panel of 19 experts. Two hundred eighty-eight vignettes were evaluated for the appropriateness of each of six options: naproxen, non-naproxen nonselective NSAIDs, naproxen plus proton pump inhibitor (PPI)/misoprostol, non-naproxen nonselective NSAID plus PPI/misoprostol, cyclooxygenase-2 selective NSAID (coxib), or coxib plus PPI/misoprostol. Using a two-stage modified Delphi process, the panel anonymously ranked the appropriateness of each option from 1 (extremely inappropriate) to 9 (extremely appropriate). Vignettes were considered appropriate if > or = 80% of all panelists' scores were 7-9 and inappropriate if > or = 80% of all panelists' scores were 1-3.

RESULTS:

The panel rated nonselective NSAIDs as appropriate when the patient had average GI risk (< 70 yr of age; no prior upper GI event; no corticosteroids, antithrombotic agents, anticoagulants). In patients with GI risk factors, cotherapy with a PPI/misoprostol was appropriate. Either a nonselective NSAID or a coxib was rated appropriate in patients with average CV risk; naproxen was preferred in patients with high CV risk. None of the options was considered appropriate in patients with multiple GI risk factors and high CV risk.

CONCLUSIONS:

The initial choice of an NSAID (naproxen vs. others) relates to a patient's CV risk, and the need for therapy to decrease GI complications (PPI/misoprostol or coxibs) is determined by severity and number of GI risk factors.

[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Wolters Kluwer Icon for MLibrary (Deep Blue)
Loading ...
Support Center