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NSAIDs and GI and Renal Complications

NSAIDs and GI and Renal Complications. Lessons from Tennessee Medicaid population studies (and selected others). Overview. Upper GI complications of NSAIDs Age Dose/duration Corticosteroids Coumadin Renal complications Other.

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NSAIDs and GI and Renal Complications

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  1. NSAIDs and GI and Renal Complications Lessons from Tennessee Medicaid population studies (and selected others)

  2. Overview • Upper GI complications of NSAIDs • Age • Dose/duration • Corticosteroids • Coumadin • Renal complications • Other

  3. Age-specific peptic ulcer hospitalization rates by sex and NSAID use, Saskatchewan, 1982-1986 Hospitalizations per1,000 person-years Malenonusers 25 Femalenonusers 20 Maleusers Femaleusers 15 10 5 0 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85+ Age Garcia Rodriguez et al, Epidemiology 1992

  4. Hospitalizations for PUDTennessee Medicaid, age 65+, 1984-86 Griffin et al Ann Intern Med 1991

  5. Gastrointestinal Complicationsmeta-analysis: 5 studies that included dose Henry et al Br Med J 1996

  6. Hospitalizations for PUDTennessee Medicaid, age 65+, 1984-86 Smalley et al Am J Epidemiol 1995

  7. Hospitalizations for PUDTennessee Medicaid, age 65+, 1984-86 Smalley et al Am J Epidemiol 1995

  8. Corticosteroids and NSAIDs • Co-prescription 1-3% of elderly • Similar to non-NSAID users • Increases risk 13-15 fold over non-users • Ulcer hospitalization: 5-6 per 100 per year

  9. Coumadin and NSAIDs • Co-prescription 1-2% of elderly • Similar to non-NSAID users • Increases risk of GI bleeding 12 fold over non-users • Ulcer hospitalization: 3 per 100 per year

  10. NSAIDs and Acute Renal Failure,Tennessee Medicaid, aged 65+, 1987-1991 • 1799 patients community acquired ARF • 4.5 hospitalization per 1000 person-years • Median length of stay 8 days • 3% dialysis • 30 day mortality 36%

  11. 18% NSAID users Adjusted RR 1.58 Other risk factors Older age Male gender Black race Nusing home resident Diuretics ACE inhibitors Other co-morbidity NSAIDs and other risk factors for ARF

  12. Individual NSAIDs NSAID RR 95% CI • Ibuprofen 1.63 (1.23 to 2.08) • Naproxen 1.03 (0.68 to 1.56) • Ketoprofen 1.55 (0.54 to 4.45)

  13. Ibuprofen dose and ARF Tennessee Medicaid, age 65+, 1984-86 Griffin et al Am J Epidemiol 2000

  14. Duration of NSAID use and ARF Tennessee Medicaid, age 65+, 1984-86 Griffin et al Am J Epidemiol 2000

  15. Other Considerations: Upper GI and renal effect • OTC drugs may be self-administered as previously “prescribed” (high dose) • OTC drugs may be used for long duration • Risk increases with combination of >1 NSAID • For GI events risk increases with aspirin use

  16. Other Considerations: Important other adverse effects • Hypertension • Small increases in mean BP, large population effect • Small bowel and lower GI bleeding • Dyspepsia • Increased health care costs • Other

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