Abstract
BackgroundThe aim of this study was to describe the use of gastrointestinal (GI) protection before, during and after hospitalisation for elderly patients using NSAID or low-dose ASA.MethodsThis study included all elderly patients (75+) admitted to hospital in the period of 1st April 2010 to 31st March 2011 at Odense University Hospital, Denmark, who were regular users of NSAID or low-dose ASA before hospital admission, or had one of these drugs initiated during hospital stay. By using pharmacy dispensing data and a hospital-based pharmacoepidemiological database, the treatment strategy for the individual patients was followed across hospital stay.ResultsIn total, 3,587 patients were included. Before hospital admission, 93 of 245 NSAID users (38.0%) and 597 of 1994 user of low-dose ASA (29.9%) had used GI protection. During hospital stay, use of GI protection increased to 75% and 33.9%, respectively. When hospital physicians initiated new treatment with NSAID or with low-dose ASA, 305 of 555 (55.0%) and 647 of 961 (67.3%) were initiated without concomitant use of GI protection. When hospital physicians initiated GI protection, 26.8–51.0% were continued in primary care after discharge.ConclusionsDuring hospital stay, the use of GI protection increases, but when new treatment with NSAIDs or low-dose ASA is initiated in hospital, the use of gastrointestinal protection is low. The low use of GI protection is carried on in primary care after discharge.
Highlights
The association between non-steroidal anti-inflammatory drugs (NSAID) and aspirin/acetylsalicylic acid (ASA) and risk of major gastrointestinal events, including symptomatic peptic ulcers and peptic ulcer complications is well documented [1,2,3]
In the same time period, we identified all patients (75+ years) who had NSAID or low-dose ASA initiated during hospital stay
Setting The data for this study were retrieved from three registers: Odense University Pharmacoepidemiological Database (OPED), Odense University Hospital Pharmacoepidemiological Database (OUHPED) and Funen County Patient Administrative System (FPAS)
Summary
The association between non-steroidal anti-inflammatory drugs (NSAID) and aspirin/acetylsalicylic acid (ASA) and risk of major gastrointestinal events, including symptomatic peptic ulcers and peptic ulcer complications is well documented [1,2,3]. Certain risk factors are associated with an increased risk of gastrointestinal complications while taking NSAIDs and low-dose ASA: A history of peptic ulcer, Helicobacter Pylori infection and concurrent use of corticosteroids, SSRI or antithrombotic drugs [7,8]. Gastrointestinal complications in elderly patients treated with NSAID and low-dose ASA can be prevented. PPIs are recommended as GI protection for elderly patients treated with low-dose ASA for secondary prevention of cardiovascular disease. Guidelines recommend that high age, concomitant use of corticosteroids, SSRI, antiplatelet therapy and previous GI complications should lead to discontinuation or to use of GI protection [13,14,15,16,17,18]. The aim of this study was to describe the use of gastrointestinal (GI) protection before, during and after hospitalisation for elderly patients using NSAID or low-dose ASA
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