查看文章

We conducted a hospital-based casecontrol study at the Kantonsspital Winterthur, encompassing 74 patients with a first-time GI bleeding in the year 2005 and 148 controls, matched to cases on age, sex and calendar time. Multivariate models including various drugs and comorbidities revealed a significant risk for GI bleeding for treatment with nonsteroidal antiinflammatory drugs (NSAIDs)(odds ratio [OR] 8.6, 95% confidence interval [CI] 3.1–23) and thrombocyte aggregation inhibitors (OR 2.2, 95% CI 1.1–4.6). Anticoagulation alone in the therapeutic international normal ratio (INR) range was not associated with bleedings (OR 0.9, 95% CI 0.4–2.3), but INR values≥ 4 were associated with an increased bleeding risk (OR 13, 95% CI 1.2–150). DDI models yielded increased risk estimates for combined use of NSAID and glucocorticoids (OR 20, 95% CI 1.6–257), and for combined use of oral anticoagulants and NSAIDs (8 cases, 0 controls, crude OR approx. 20). The findings of this small hospitalbased case-control analysis suggest that a firsttime GI bleeding is associated with INR values above the therapeutic range, but not with wellcontrolled oral anticoagulation in the absence of other risk factors such as DDIs. The combinations of glucocorticoids or oral anticoagulants with NSAIDs carry a high risk for GI bleeding.