1.The Effect of Aspirin Alone or Aspirin Plus Additional Antiplatelets Therapy on Upper Gastrointestinal Hemorrhage.
Suh Eun BAE ; Seong Eun KIM ; Sung Ae JUNG ; So Yoon YOON ; Ki Nam SHIM ; Hye Kyung JUNG ; Tae Hun KIM ; Kwon YOO ; Il Hwan MOON
The Korean Journal of Gastroenterology 2011;57(4):213-220
BACKGROUND/AIMS: The increasing incidence of cardiovascular disease has led to an increase in the frequency of upper gastrointestinal (GI) hemorrhage due to the use of antiplatelet agents. This study examined the clinical characteristics of patients with upper GI hemorrhage who were administered aspirin alone or a combination treatment of antiplatelet agents. METHODS: A 656 patients who underwent drug-eluting coronary stenting at Ewha Mokdong Hospital in 2008 were divided into three groups according to the antiplatetlet agents used after the intervention; groups of aspirin alone, aspirin plus clopidogrel, and aspirin, and clopidogrel plus another antiplatelet agent, respectively. Patients admitted with GI hemorrhage in the same period without a medication history of antiplatelet or nonsteroidal anti-inflammatory drugs were used as the control hemorrhage group. The medical records were reviewed. RESULTS: Significant GI symptoms were observed in 21.1% of total patients, of whom 48.2% had ulcers. The upper GI hemorrhage rate was 3.8%. There was no significant difference in the hemorrhage rate between three groups. Compared to the control hemorrhage group, the endoscopic variables of the antiplatelet-related hemorrhage group were not significantly different. However, the Helicobacter pylori infection rate was lower, the admission period was longer, and the mortality rate was higher in the antiplatelet-related hemorrhage group (p<0.05, respectively). There was no direct association between restarting or discontinuance of antiplatelets after the hemorrhage event and mortality. CONCLUSIONS: Adding other antiplatelet agents to aspirin did not increase the hemorrhage rate. However, active diagnostic and therapeutic efforts are recommended in patients with GI symptoms during antiplatelet therapy.
Aged
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Aspirin/*adverse effects/therapeutic use
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Cardiovascular Diseases/prevention & control
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Drug Therapy, Combination
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Drug-Eluting Stents
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Endoscopy, Gastrointestinal
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Female
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Gastrointestinal Hemorrhage/*chemically induced/mortality/prevention & control
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Helicobacter Infections/complications/epidemiology
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Helicobacter pylori
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Humans
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Male
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Middle Aged
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Peptic Ulcer/complications/epidemiology
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Platelet Aggregation Inhibitors/*adverse effects/therapeutic use
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Retrospective Studies
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Risk Factors
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Ticlopidine/adverse effects/analogs & derivatives/therapeutic use
2.Prescription Pattern of NSAIDs and the Prevalence of NSAID-induced Gastrointestinal Risk Factors of Orthopaedic Patients in Clinical Practice in Korea.
Sung Hun LEE ; Chang Dong HAN ; Ick Hwan YANG ; Chul Won HA
Journal of Korean Medical Science 2011;26(4):561-567
This is a cross-sectional observational study undertaken to explore the current prescription pattern of non-steroidal anti-inflammatory drugs (NSAIDs) and the prevalence of NSAID-induced gastrointestinal (GI) risk factors of orthopaedic patients in real clinical practice in Korea. Study cohort included 3,140 orthopaedic outpatients at 131 hospitals and clinics between January 2008 and August 2008. A self-administered questionnaire was completed by each patient and physician. A simplified risk scoring scale (the Standardized Calculator of Risk for Events; SCORE) was used to measure patients' risk for GI complications. The pattern of NSAIDs prescription was identified from medical recordings. Forty-five percents of the patients belonged to high risk or very high risk groups for GI complications. The cyclooxygenase-2 enzyme (COX-2) selective NSAID showed a propensity to be prescribed more commonly for high/very high GI risk groups, but the rate was still as low as 51%. In conclusion, physician's considerate prescription of NSAIDs with well-understanding of each patient's GI risk factors is strongly encouraged in order to maximize cost effectiveness and to prevent serious GI complications in Korea. Other strategic efforts such as medical association-led education programs and application of Korean electronic SCORE system to hospital order communication system (OCS) should also be accompanied in a way to promote physician's attention.
Adult
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Aged
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Aged, 80 and over
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Anti-Inflammatory Agents, Non-Steroidal/*adverse effects
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Cohort Studies
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Cross-Sectional Studies
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Cyclooxygenase 2/metabolism
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Cyclooxygenase 2 Inhibitors/adverse effects
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Drug Prescriptions
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Female
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Gastrointestinal Diseases/chemically induced/complications/*epidemiology
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Humans
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Male
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Middle Aged
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Musculoskeletal Diseases/complications/*drug therapy
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Prevalence
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Questionnaires
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Republic of Korea
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Risk Factors