Summary
The possibility has been investigated that, after admission to hospital with acute upper gastrointestinal bleeding, patients who have been users of aspirin and non-aspirin non-steroidal anti-inflammatory drugs have poorer baseline renal. function, a greater improvement in renal function during their hospital stay, and a larger transfusion requirement than non-users. Patients over 50 years of age admitted to public hospitals with acute upper gastrointestinal bleeding were studied. Creatinine clearance was estimated from serum creatinine and the transfusion requirement was recorded as the number of units of blood transfused on Day 1 and throughout the entire hospital stay. Data were obtained prospectively from case notes and by structured interview.
Users of non-steroidal anti-inflammatory drugs were significantly older than non-users. The estimated creatinine clearance on admission to hospital declined with age. Creatinine clearance was 13.2 (95 % CI 6.0 to 20.4) ml · min' lower in users than non-users of non-aspirin non-steroidal anti-inflammatory drugs. However, the difference was attributable to the older age of the drug users rather than to the drugs themselves.
On average, the increase in creatinine clearance during hospital stay was the same in users and non-users of non-aspirin non-steroidal anti-inflammatory drugs. Prior use of aspirin had no effect on any measure of renal function. The incidence of blood transfusion was higher in older than in younger patients but neither the incidence of transfusion, nor the transfusion requirement, was different between users and non-users of non-aspirin non-steroidal anti-inflammatory drugs and aspirin.
Although the study has not excluded certain adverse effects of prior use of these drugs on renal and haemostatic function after an episode of upper gastrointestinal bleeding, it does indicate that such change are unlikely to be of major clinical significance.
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References
Somerville K, Faulkner G, Langman M (1986) Non-steroidal anti-inflammatory drugs and bleeding peptic ulcer. Lancet 1: 462–464
Blower AL, Armstrong CP (1986) Ulcer perforation in the elderly and non-steroidal ant-inflammatory drugs. Lancet 1: 1971 (letter)
Henry DA, Johnston A, Dobson A, Duggan J (1987) Fatal peptic ulcer complications and the use of non-steroidal ant-inflammatory drugs, aspirin and corticosteroids. Br Med J 295: 1227–1229
Blower AL, Armstrong CP (1987) Non-steroidal anti-inflammatory drugs and complications of peptic ulceration. Gut 28: 527–532
Griffin MR, Ray WA, Schaffner W (1988) Non-steroidal anti-inflammatory drug use and death from peptic ulcer in elderly persons. Ann Intern Med 109: 359–363
Clive DM, Stoff JS (1984) Renal syndromes associated with nonsteroidal anti-inflammatory drugs. N Engl J Med 310: 563–572
Del Favero A. Anti-inflammatory analgesics and drugs used in rheumatoid arthritis and gout. In: Dukes MNG, Beely L (eds) Side effects of drugs. Annual 11. Elsevier, Amsterdam, pp 82–106
Mustard JF, Kinlough-Rathbourne RL, Packam MA (1980) Prostaglandins and platelets. Ann Rev Med 31: 89–96
McQueen EG, Facoory B, Faed JM (1986) Non-steroidal anti-inflammatory drugs and platelet function. NZ Med J 99: 358–360
Sethi KG, Copeland JG, Goldman S et al. (1990) Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting. Department of Veterans Affairs Cooperative Study on Antiplatelet Drugs. J Am Coll Cardiol 15: 15–20
Taggart DP, Siddiqui A, Wheatley DJ (1990) Low-dose preoperative aspirin therapy, postoperative blood loss, and transfusion requirements. Ann Thorac Surg 50: 424–428
Henry DA, Dobson A, Turner C et al. (1991) NSAIDs and risk of upper gastrointestinal bleeding. Lancet 337: 370
Cockroft DW Gault Mll (1976) Prediction of creatinine from serum creatinine. Nephron 16: 31–41
Heinrich WL, Anderson RL, Berns et al. (1978) The role of renal nerves and prostaglandins in central control of renal hemodynamics and plasma renin activity during hypotensive hermorrhage in the dog. J Clin Invest 61: 744–750
Stuart MJ, Murphy S, Oski FA (1975) A simple non-radioisotopic technique for the determination of platelet life span. N Engl J Med 292: 1310–1313
Bricker SR, Savage ME, Harming CD (1987) Peri-operative blood loss and non-steroidal anti-inflammatory drugs: an investigation using diclofenac in patients undergoing transurethral resection of the prostate. Eur J Anaesthesiol 4: 429–434
Silverstein FE, Gilbert DA, Tedesco FJ et al. (1981) The National ASGE survey on upper gastrointestinal bleeding: II. Clinical prognostic factors. Gastrointest Enclose 27: 80–93
Duhamel C, Czernichow P, Dechelotte P et al. (1989) Upper gastrointestinal hemorrhage caused by anti-inflammatory drugs. Gastroenterol Clin Biol 13: 239–244
Griffin MR, Piper JM, Daugherty JR et al. (1991) Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med 114: 257–263
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Henry, D.A., MacGregor, P.R., Dobson, A. et al. Effects of prior use of non-steroidal anti-inflammatory drugs on renal function and transfusion requirements after upper gastrointestinal haemorrhage. Eur J Clin Pharmacol 43, 341–345 (1992). https://doi.org/10.1007/BF02220606
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DOI: https://doi.org/10.1007/BF02220606