Focus on GI Risks of Over-the-Counter NSAIDs柜台NSAIDs对胃肠道风险集中.pptVIP

RISKS of NSAIDS: Focus on GI Risks of Over-the-Counter NSAIDs Byron Cryer, M.D. University of Texas Southwestern Medical School NSAIDs: What Are the Risks? Prescription OTC GI Tract Ulcers, perforations, bleeding, obstruction strictures, enteropathy Kidney Sodium and fluid retention Hyperkalemia Acute renal failure Hypertension Platelet Inhibition of aggregation leading to increased potential for bleeding Prevalence of EndoscopicNSAID-Induced Ulceration Mean Range Gastric Ulcer 15 % 10 to 30% Duodenal Ulcer 5 % 4 to 10 % Clinically Significant Ulcers 2% 1 to 4% Risk Factors forSerious GI Adverse Events with NSAIDs: Relative Risks OTC NSAIDs: What Are the GI Risks? OTC NSAIDS / Low-Dose Aspirin: Non-Aspirin NSAIDs Low Dose Aspirin Non-Aspirin NSAIDs in combination with Low-Dose Aspirin NSAIDs plus ETOH Acetaminophen and Gastrointestinal Injury Hepatotoxicity with NSAIDs Prevalence of NSAID Use in Patients Presenting with Upper GI BleedingPatient History (n = 411) Prevalence of OTC Analgesic Use in Patients Presenting with GI Bleeding NSAID Dose andRelative Risk of Upper GI Complications Risks of GI Bleeding with Analgesics:Prescription OTC  GI Bleeding According to Dose ofOTC Ibuprofen Use OTC NSAID Usage Patterns (n=535 OTC NSAID Users) Relative Risk of GI Problems in the Previous 30 Days with OTC NSAIDS Medications Taken in the Previous 30 Daysfor GI Problems by OTC NSAID Users OTC NSAIDs: What Are the GI Risks? OTC NSAIDS / Low-Dose Aspirin: Non-Aspirin NSAIDs Low Dose Aspirin Non-Aspirin NSAIDs in combination with Low-Dose Aspirin NSAIDs plus ETOH Acetaminophen and Gastrointestinal Injury Hepatotoxicity with NSAIDs Prior Placebo-Controlled Study of Low Dose ASA for Prevention of Cerebrovascular Events Daily Aspirin Dose andAdmission for Ulcer Bleeding Mechanisms of NSAID/ Aspirin-induced Mucosal Injury Alterations in gastric mucosal barrier ? Prostaglandin synthesis ? Mucus and bicarbonate secretion ?