Journal
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY
Volume 29, Issue 10, Pages 1786-1793Publisher
WILEY-BLACKWELL
DOI: 10.1111/jgh.12595
Keywords
acetylsalicylic acid; acute lower gastrointestinal bleeding; antithrombotic drug; colonic diverticular bleeding; dual antiplatelet therapy
Categories
Funding
- Ministry of Health Labor and Welfare of Japan
- Ministry of Education, Culture, Sports, Science, and Technology of Japan [271000]
- National Center for Global Health and Medicine [22-302]
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Background and AimThe effects of various medications on lower gastrointestinal tract remains unknown. Here, we investigated the effects of nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin, and antiplatelet drugs associated with diverticular bleeding. MethodsThis prospective study involved patients with diverticulosis who underwent colonoscopy. Alcohol and smoking, medications, and Charlson comorbidity index and Gastrointestinal Symptom Rating Scale scores were assessed. The medications evaluated were nine kinds of NSAIDs, two kinds of low-dose aspirin, 10 kinds of nonaspirin antiplatelet drugs, three kinds of anticoagulants, acetaminophen, and corticosteroids. Adjusted odds ratios (aOR) were estimated by a logistic regression model. ResultsA total of 911 patients with non-bleeding diverticula (n=758) and bleeding diverticula (n=153) were enrolled. Independent risk factors were alcohol consumption (light drinker, aOR 3.4; moderate drinker, aOR 3.3), smoking index (400, aOR 2.0), NSAIDs (aOR 4.6), low-dose aspirin (aOR 1.9), and nonaspirin antiplatelet drugs (aOR 2.2). The drugs significantly associated with bleeding were loxoprofen (aOR 5.0), diclofenac (aOR 3.1), diclofenac suppository (aOR 8.0), etodolac (aOR 4.9), enteric-coated aspirin (aOR 3.9), buffered aspirin (aOR 9.9), clopidogrel (aOR 2.5), and cilostazol (aOR 7.3). Dual therapy carried a higher risk than monotherapy (single NSAID, aOR 3.6, P<0.01; dual, aOR 23, P<0.01; single antiplatelet drug, aOR 2.0, P<0.01; dual, aOR 4.1, P<0.01). ConclusionsBesides alcohol and smoking, NSAIDs, low-dose aspirin, and antiplatelet drugs are risk factors for diverticular bleeding. The magnitude of risk may differ between different kinds of NSAIDs and antiplatelet drugs, and dual therapy with NSAIDs or antiplatelet drugs increases the risk of bleeding.
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