Evaluation of Drug Use for Reducing the Risk of Gastrointestinal Bleeding in the Elderly Receiving Nonsteroidal Anti-inflammatory Drugs
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Abstract
Objective: To evaluate drug use for reducing the risk of gastrointestinal (GI) bleeding in the elderly receiving nonsteroidal anti-inflammatory drugs (NSAIDs). Methods: The study was a retrospective descriptive study in the elderly receiving NSAIDs with high risk of GI bleeding including aspirin 81 mg, aspirin 300 mg, diclofenac 50 mg, naproxen 250 mg, and piroxicam 10 mg during January 1st to December 31st, 2015. The researchers collected the data from outpatient database of Maharaj Nakorn Chiang Mai Hospital. Risk factors in the study were history of complicated GI ulcer, age from 65 years old, receiving high dose of NSAIDs, history of uncomplicated GI ulcer, concomitant use of corticosteroids or anticoagulants or other antiplatelets with NSAIDs, and receiving NSAIDs with low dose aspirin. The study classified elderly into three groups according to their risk of GI bleeding: high (three or more risk factors), medium (1-2 risk factors) and low-risk groups (no risk factor). Subsequently, prevalence of receiving medication to prevent GI bleeding in each group was assessed. Results: The majority of subjects were female (52.6%) with mean age of 69.8 years old and having hypertension as the most common disease (53.1 %). Most common risk factor was being 65 years old or more (68.2%). There were only 1.3% of elderly with history of serious GI complications. The NSAIDs mostly used in this study was aspirin 81 mg (59.9 %). Nineteen of the elderly was classified as having high risk and 73.7 % of them received antisecretory medication to prevent GE bleeding. One hundred thirty four patients from the total of 311 in moderate risk group (43.1%) received proton pump inhibitors (PPIs). Thirteen of 54 of those in low risk group (24.1%) received PPIs. The subjects receiving aspirin 81 mg were less likely to receive antisecretory medication. The most commonly prescribed PPI was omeprazole 20 mg (94.2%), whereas no prescriptions of misoprostol were found. Conclusion: Drug use for reduction the risk of GI bleeding from NSAIDs in the elderly with various risks was found to be inappropriate in particular to those receiving low dose aspirin. Therefore, evaluation of risk in GI bleeding should be performed prior to initiation of NSAIDs and gastroprotective medication should be provided if needed for safety use of the drug.
Article Details
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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