Previous use of non-steroidal anti-inflammatory drugs and anticoagulants: the influence on clinical outcome of bleeding gastroduodenal ulcers.

OBJECTIVE: To evaluate the relationship between prior non-steroidal anti-inflammatory drug (NSAID) or anticoagulant use and clinical outcome in bleeding gastric and duodenal ulcer patients.
DESIGN: Prospective cohort-study. PARTICIPANTS: All patients (n = 132) admitted because of upper gastrointestinal bleeding during 3 months in the Amsterdam area.
METHODS: We compared clinical outcome (blood transfusion, rebleeding, surgery and mortality) between ulcer patients who used NSAIDs or anticoagulants and patients who did not use these drugs before the bleeding-episode.
RESULTS: Of the 132 patients admitted, 56 patients had gastric or duodenal ulcers. NSAIDs were used significantly more often before the bleeding episode in these ulcer patients than in the non-ulcer patients (n = 76), 21/56 (37.5%) vs. 15/76 (19.7%), respectively (P < 0.05), relative risk = 2.57, 95% confidence interval: 1.04-5.77). Stigmata of recent haemorrhage were found in 16/21 (76.2%) patients in the NSAID ulcer group, in 2/9 (22.2%) in the coumarin-ulcer patients, and in 12/24 (50%) in the no-medication ulcer group (not significant). Prior NSAID usage increased the in-hospital rebleeding rate from 16.7% to 42.9% (P = 0.05), leading to an increased need for surgical intervention from 16.7% to 42.9% (P = 0.05). In contrast prior usage of anticoagulants, which could be antagonized, did not affect the clinical outcome of the bleeding. Mortality was 9.5% in the NSAID group, 0% in the coumarin group, and 4.2% in the no-medication group.
CONCLUSION: Prior use of NSAIDs increases the risk of rebleeding in bleeding ulcer patients, and leads to a higher need for urgent surgery. In contrast, prior anticoagulant therapy does not raise the rebleeding risk.