1. Home>
2. Specialties>
3. Gastroenterology>
4. Summary and Comment

Vasodilators and NSAID Toxicity

Gastrointestinal bleeding is the most important and common complication of nonsteroidal anti-inflammatory drugs (NSAIDs). One suggested mechanism of this injury is disruption of the microcirculation of the gastroduodenal mucosa through leukocyte margination. In animals, this effect can be avoided by using nitric oxide donor molecules as vasodilators. To test this effect in clinical practice, Spanish investigators performed a case-control study with 3353 patients; 1122 cases presented with bleeding peptic lesions and 2231 controls were matched for age and sex.

Among cases, 46.3 percent had used some NSAID within the past week and 5.3 percent had taken nitrovasodilators. Multivariate logistic regression, performed to determine the effect of various factors on bleeding related to NSAID use, revealed that the adjusted odds ratio for bleeding was 0.3 (95 percent CI, 0.1-0.9; P=0.04) in patients taking nitrovasodilators, suggesting a 70 percent reduction in bleeding risk compared with patients not taking nitrates. Other factors that were associated with bleeding were a history of GI bleeding (OR, 3.7) and aspirin at any dose (OR, 3.1). A history of acid-reduction medication reduced the risk for bleeding (OR, 0.4). The same predictive factors were significant with any dose of aspirin. The use of other NSAIDs was also an independent risk factor for bleeding. The authors concluded that nitrovasodilators decrease the risk for bleeding in patients who use aspirin or other NSAIDs.

Comment: The results of this study support the theory that enhancing mucosal blood flow reduces the risk of NSAID-associated bleeding. The data also confirm the role of multiple-NSAID use and complicated ulcer disease as important risk factors for NSAID-associated bleeding.

— DJ Bjorkman

Published in Journal Watch Gastroenterology October 23, 2000

Citation(s):

Lanas A et al. Nitrovasodilators, low-dose aspirin, other nonsteroidal antiinflammatory drugs, and the risk of upper gastrointestinal bleeding. N Engl J Med 2000 Sep 343 834-839.

• Original article (Subscription may be required)
• Medline abstract (Free)