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aspirin and gastrointestinal bleeding

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7561. Should all patients taking either an NSAID, COX I or COX II with GI issues, who still require their medication, now be co-prescribed a PPI?

of celecoxib in preventing severe GI complications compared to diclofenac. COX-2 selective inhibitors remain associated with serious and fatal GI side-effects. No fully published studies of large RCTs with serious gastrointestinal events as primary outcome are available for etoricoxib or valdecoxib. Any lower risk of GI complications as compared to traditional NSAIDs is eliminated if patients also take an anti-platelet agent such as aspirin. Additional gastro protection in the form of PPIs, H2RAs (...) that (3) o cox-2 inhibitors, as a class, are associated with a lower GI risk than traditional NSAIDs. However, their GI-safety advantage is diminished when co-administered with aspirin o of the traditional NSAIDS, low-dose ibuprofen is associated with a lower GI risk than diclofenac and naproxen o use of a proton pump inhibitor (PPI) with any NSAID significantly reduces the risk of GI side effects o benefits from gastroprotection largely depend on the baseline risk that the individual has for GI

2008 TRIP Answers

7562. Chemoprevention of colorectal cancer by aspirin: a cost-effectiveness analysis

2002; 122(1): 78-84 PubMedID Other publications of related interest Greenberg ER, Baron JA, Freeman DH Jr, et al. Reduced risk of large bowel adenomas among aspirin users. Journal of the National Cancer Institute 1993;85:912-6. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. New England Journal of Medicine 1993;329:1977-81. Muller A D, Sonnenberg A. Prevention of colorectal cancer by flexible endoscopy: a case control study of 32,702 veterans (...) services included in the economic evaluation were aspirin prevention, aspirin prevention and management of gastrointestinal side effects, COL, polypectomy, bleeding, perforation and medical care for incurable CRC. The latter (medical care) covered expenses for diagnosis, surgery, radiation and chemotherapy. The cost/resource boundary of the third-party payer was used. The costs were estimated from several sources, including published studies and Medicare reimbursement rates. Some costs and resource use

2002 NHS Economic Evaluation Database.

7563. After CABG surgery does enteric-coated aspirin result in a lower incidence of gastrointestinal complications compared to normal aspirin?

) Gastric Mucosal damage. Mean score of patients with gastric mucosal injury Placebo = 0.72 (sd = 1.07). ASA= 2.33 (sd = 1.06). Buffered Aspirin =1.60 (sd = 1.43). ECA =0.90 (sd = 1.26) Kelly et al, 1996, UK 550 cases of patients admitted with melaena or haematemesis, confirmed by endoscopy, versus 1202 control identified from census Multicentre case control study ( level 3b ) calculation of relative risk of GI bleed Relative risk of UGIB with 325mg or less :Plain aspirin 2.6 Buffered aspirin 2.7 (...) on mucosal lining Conclusion is that most of the studies suggest that the use of enteric coated aspirin was associated with less mucosal damage. Search strategy not reported. No tabulated summary of papers, or attempt to aggregate data. Comment(s) The evidence surrounding enteric-coated aspirin (ECA) falls into two clear categories. Some studies selected random volunteers, confirmed good gastric-health via endoscopy and administered ECA or ASA (acetylsalicylic acid) for a period of time before repeat

2007 BestBETS

7564. A controlled comparison of aspirin and oral anticoagulants in prevention of death after myocardial infarction. (Abstract)

with gastrointestinal events in the aspirin group and four times more patients with episodes of severe bleeding in the anticoagulant group. We conclude that aspirin in the dosage used in probably not different from oral anticoagulants in affecting mortality and morbidity after a myocardial infarction. However, this study does not consider the effectiveness of either agent in comparison to no antithrombotic therapy -- an issue that remains unsettled. (...) A controlled comparison of aspirin and oral anticoagulants in prevention of death after myocardial infarction. Although neither aspirin nor oral anticoagulants have been conclusively shown to reduce mortality in patients surviving myocardial infarction, both have been widely used for that purpose. In the present clinical trial we compared the effects of aspirin (0.5 g given three times a day) and oral-anticoagulant therapy. Of 6908 patients considered for entry, 1303 were randomized

1982 NEJM Controlled trial quality: uncertain

7565. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. (Abstract)

a statistically significant (p = 0.043) relative-risk reduction of 8.7% in favour of clopidogrel (95% Cl 0.3-16.5). Corresponding on-treatment analysis yielded a relative-risk reduction of 9.4%. There were no major differences in terms of safety. Reported adverse experiences in the clopidogrel and aspirin groups judged to be severe included rash (0.26% vs 0.10%), diarrhoea (0.23% vs 0.11%), upper gastrointestinal discomfort (0.97% vs 1.22%), intracranial haemorrhage (0.33% vs 0.47%), and gastrointestinal (...) haemorrhage (0.52% vs 0.72%), respectively. There were ten (0.10%) patients in the clopidogrel group with significant reductions in neutrophils (< 1.2 x 10(9)/L) and 16 (0.17%) in the aspirin group.Long-term administration of clopidogrel to patients with atherosclerotic vascular disease is more effective than aspirin in reducing the combined risk of ischaemic stroke, myocardial infarction, or vascular death. The overall safety profile of clopidogrel is at least as good as that of medium-dose aspirin.

1996 Lancet Controlled trial quality: predicted high

7566. A comparison of two doses of aspirin (30 mg vs. 283 mg a day) in patients after a transient ischemic attack or minor ischemic stroke. The Dutch TIA Trial Study Group. (Abstract)

attack or minor ischemic stroke.We assessed the effects of two doses of a water-soluble preparation of acetylsalicylic acid, or aspirin (30 mg vs. 283 mg a day), on the occurrence of death from all vascular causes, nonfatal stroke, or nonfatal myocardial infarction in a double-blind, randomized, controlled clinical trial in patients who had had a transient ischemic attack or minor stroke. A total of 3131 patients participated in the study. The mean follow-up was 2.6 years.In the group assigned (...) fewer reports of minor bleeding (49 vs. 84). Fewer patients receiving 30 mg of aspirin reported gastrointestinal symptoms (164 vs. 179) and other adverse effects (73 vs. 90).Our data indicate that 30 mg of aspirin daily is no less effective in the prevention of vascular events than a 283-mg dose in patients with a transient ischemic attack or minor stroke, and has fewer adverse effects.

1991 NEJM Controlled trial quality: predicted high

7567. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study. (Abstract)

) as compared with 21 (3.3 per cent)--although it was not statistically significant; P = 0.054. There was no difference in gastrointestinal symptoms or evidence of blood loss between the treatment and control groups. Our data show that aspirin has a protective effect against acute myocardial infarction in men with unstable angina, and they suggest a similar effect on mortality. (...) Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study. We conducted a multicenter, double-blind, placebo-controlled randomized trial of aspirin treatment (324 mg in buffered solution daily) for 12 weeks in 1266 men with unstable angina (625 taking aspirin and 641 placebo). The principal end points were death and acute myocardial infarction diagnosed by the presence of creatine kinase MB

1983 NEJM Controlled trial quality: predicted high

7568. Trial of low-dose aspirin plus dipyridamole versus anticoagulants for prevention of aortocoronary vein graft occlusion. (Abstract)

as standard anticoagulant therapy to prevent early and late graft occlusion. Death, myocardial infarction, and severe bleeding occurred significantly more often in patients receiving anticoagulants, whereas mild drug-related gastrointestinal and cerebral side-effects were more common in patients taking platelet inhibitory drugs. Antithrombotic treatment should be continued for at least 1 year after coronary artery bypass graft surgery. (...) Trial of low-dose aspirin plus dipyridamole versus anticoagulants for prevention of aortocoronary vein graft occlusion. In a prospective randomised trial, 249 patients who had aortocoronary vein bypass surgery were assigned either to a platelet inhibitory drug regimen or to standard anticoagulant therapy. Treatment was replaced by placebo in half of the patients in each group after 3 months. The platelet inhibitory drug regimen--very low-dose aspirin combined with dipyridamole--was as effective

1989 Lancet Controlled trial quality: uncertain

7569. Aspirin and mortality from coronary bypass surgery. (Abstract)

in the incidence of bowel infarction (0.3 percent vs. 0.8 percent, P=0.01). Multivariate analysis showed that no other factor or medication was independently associated with reduced rates of these outcomes and that the risk of hemorrhage, gastritis, infection, or impaired wound healing was not increased with aspirin use (odds ratio for these adverse events, 0.63; 95 percent confidence interval, 0.54 to 0.74).Early use of aspirin after coronary bypass surgery is safe and is associated with a reduced risk (...) 48 hours after surgery. We gathered data on 7500 variables per patient and adjudicated outcomes centrally. The primary focus was to discern the relation between early aspirin use and fatal and nonfatal outcomes.During hospitalization, 164 patients died (3.2 percent), and 812 others (16.0 percent) had nonfatal cardiac, cerebral, renal, or gastrointestinal ischemic complications. Among patients who received aspirin (up to 650 mg) within 48 hours after revascularization, subsequent mortality was 1.3

2002 NEJM

7570. Nitric Oxide-Releasing Acetylsalicyclic Acid in Preventing Colorectal Cancer in Patients at High Risk of Colorectal Cancer

First Posted: May 31, 2006 Last Update Posted: February 9, 2009 Last Verified: May 2007 Keywords provided by National Cancer Institute (NCI): colon cancer rectal cancer Additional relevant MeSH terms: Layout table for MeSH terms Colorectal Neoplasms Intestinal Neoplasms Gastrointestinal Neoplasms Digestive System Neoplasms Neoplasms by Site Neoplasms Digestive System Diseases Gastrointestinal Diseases Colonic Diseases Intestinal Diseases Rectal Diseases Nitric Oxide Aspirin Nitroaspirin (...) on flexible sigmoidoscopy No history of gastrointestinal (GI) cancer other than colorectal cancer No inherited colorectal cancer syndromes PATIENT CHARACTERISTICS: No other GI mucosal epithelial diseases (e.g., Barrett's esophagus, chronic or recurrent peptic ulcer disease, celiac sprue, or other disorders of nutrient absorption) No active peptic ulcer disease No history of inflammatory bowel disease (ulcerative colitis or Crohn's disease) No known or suspected alcohol ( > 5 glasses of wine or beer per

2006 Clinical Trials

7571. Folate-Depleted Diet Compared With Folate-Supplemented Diet in Preventing Colorectal Cancer in Patients at High Risk for Colorectal Cancer

Cancer Institute ClinicalTrials.gov Identifier: Other Study ID Numbers: CDR0000393455 RUH-PHO-0514-0404 RPCI-EPR-20703 AECM-0401022E NEMCH-6060 First Posted: November 9, 2004 Last Update Posted: January 13, 2014 Last Verified: January 2014 Keywords provided by Roswell Park Cancer Institute: colon cancer rectal cancer Additional relevant MeSH terms: Layout table for MeSH terms Colorectal Neoplasms Intestinal Neoplasms Gastrointestinal Neoplasms Digestive System Neoplasms Neoplasms by Site Neoplasms (...) Digestive System Diseases Gastrointestinal Diseases Colonic Diseases Intestinal Diseases Rectal Diseases Folic Acid Vitamin B Complex Hematinics Vitamins Micronutrients Nutrients Growth Substances Physiological Effects of Drugs

2004 Clinical Trials

7572. Chemotherapy for colorectal cancer prior to liver resection for colorectal cancer hepatic metastases does not adversely affect peri-operative outcomes. (Abstract)

metastases were half as common (25% vs. 49%) in the chemotherapy group. Liver resection operative time was equivalent (270 min) in the two groups. Higher estimated blood loss (EBL) (1,000 ml vs. 850 ml), but fewer transfusions (23% vs. 15%) were associated with the chemotherapy group. Although not statistically significant, post-operative liver enzyme peaks were higher in the chemotherapy group (AST = 402 U/L vs. 302 U/L, P = 0.09 and ALT = 433 U/L vs. 312 U/L, P = 0.1). Peak changes in INR and serum (...) , 1-2 years, and >2 years) revealed a trend towards worse outcomes in most categories for those in the >2 years cohort. When comparing the 5-FU/LV alone, to the CPT-11 group there were no significant differences except higher intra-operative blood loss in the group receiving 5-FU/LV alone (1,295 ml vs. 756 ml, P = 0.01).Despite variations in biochemical function and hepatic steatosis, short-term clinical outcomes are not affected by the administration of chemotherapy prior to hepatic resection

2007 Journal of Surgical Oncology

7573. Continuous thoracic epidural analgesia versus combined spinal/thoracic epidural analgesia on pain, pulmonary function and the metabolic response following colonic resection. (Abstract)

by combining preoperative high spinal anaesthesia with postoperative thoracic epidural anaesthesia. In theory too, there may be additional benefits over perioperative thoracic epidural anaesthesia on pain and pulmonary dysfunction.20 ASA 1-3 patients undergoing elective colonic surgery were studied. Gp 1 (n = 10) received a high spinal intraoperative block to T4 using 6mls of 0.5% bupivacaine plus continuous epidural 0.125% bupivacaine/0.0025% diamorphine. Gp 2 (n = 10) patients received epidural 0.5 (...) and noradrenaline f) 24-hour PCA morphine requirements.The two groups did not differ in age, sex, height, weight, duration of surgery, blood loss or serum albumin. Pain relief was excellent and similar in both groups. The average 24 hour morphine consumption was 10 mg in both groups with no differences in the block height. All the patients had a 30-50% reduction in FEV1, FVC and PFR (P > 0.05). Metabolically, there was no statistical difference between the 2 groups except a higher rise in glucose in Gp1 at 2

1996 Acta Anaesthesiologica Scandinavica Controlled trial quality: uncertain

7574. Epidural analgesia with local anesthetics after abdominal surgery: earlier motor recovery with 0.2% ropivacaine than 0.175% bupivacaine. (Abstract)

, including motor blockade (Bromage score), were similar in both groups, but mobilization recovered more quickly in Group 1. Gender, age, ASA physical status, duration of surgery, and intraoperative blood loss had no effect on mobilization. We conclude that epidural analgesia is effective and safe with both regimens. There is not necessarily a correlation between the Bromage score and the desired outcome of mobilization. The ability to walk postoperatively is hastened if ropivacaine is used instead (...) Epidural analgesia with local anesthetics after abdominal surgery: earlier motor recovery with 0.2% ropivacaine than 0.175% bupivacaine. The aim of this prospective, randomized, double-blinded study was to compare pain relief, side effects, and ability to ambulate during epidural anesthesia with ropivacaine 0.2% plus sufentanil versus bupivacaine 0.175% plus sufentanil after major gastrointestinal surgery. Epidural catheters were inserted at T8-11, and 30 microg of sufentanil with 15 mL

1999 Anesthesia and analgesia Controlled trial quality: uncertain

7575. [Comparison of sufentanil-propofol-anesthesia with fentanyl-propofol in major abdominal surgery]. (Abstract)

[Comparison of sufentanil-propofol-anesthesia with fentanyl-propofol in major abdominal surgery]. Major abdominal surgery often leads to a marked sympathoadrenal stress response with high concentrations of plasma catecholomines, hypertension, and tachycardia. We compared the effects of sufentanil-propofol with fentanyl-propofol anaesthesia in a controlled, randomised, double-blind study of 18 ASA I-II patients aged 23-64 years undergoing major abdominal surgery. Study parameters were (...) of surgery. Relaxation was obtained with pancuronium 0.025-0.05 mg/kg before and after induction, after tracheal intubation, before and after skin incision, after opening of the peritoneum, and at the end of surgery.No significant differences were observed between the two groups with regard to the study parameters. The duration of surgery and blood loss were similar in both groups, as were patient characteristics. After induction 2 patients in each group developed thoracic rigidity, which was reversible

1996 Der Anaesthesist Controlled trial quality: uncertain

7576. [The effect of convection warming during abdominal surgery on the early postoperative heat balance]. (Abstract)

[The effect of convection warming during abdominal surgery on the early postoperative heat balance]. Hypothermia (core temperature < 36 degrees C) is common after longer-lasting surgical procedures. Heat loss mainly occurs during anaesthesia and surgery and leads to increased risk, especially in the early recovery period of elderly patients. In the present study we investigated the effects of intraoperative forced-air warming, administered via an upper-body blanket ("Warm Touch", Mallinckrodt (...) , USA), with the specific aims of: (1) drawing up heat balances; and (2) analysing postoperative thermoregulation, oxygen consumption (VO2) and cardiovascular reactions of mechanically ventilated patients. The general aim of our study was to compare intraoperative forced-air-warming and conventional patient-insulation with cotton blankets.Twenty four ASA II and III patients scheduled for elective colon surgery were randomly assigned to a control group (n = 12, no warming therapy, upper body covered

1996 Der Anaesthesist Controlled trial quality: uncertain

7577. [Ketorolac versus tramadol: comparative study of analgesic efficacy in the postoperative pain in abdominal hysterectomy]. (Abstract)

(Ketorolac) group 30 mg administered every 6 hours intravenously. Patients were ASA I-II and aged 35 to 65 years old. Patients were excluded from the study if hysterectomy was performed because of a tumor, or if there was a history of bleeding dyscrasias, of gastric or duodenal ulcers or of allergy to drugs in the study or if other analgesics had been used within 15 days of surgery. Analgesic efficacy was assessed using a visual analog scale (VAS) and a verbal response scale (VRS). Need for top-up (...) [Ketorolac versus tramadol: comparative study of analgesic efficacy in the postoperative pain in abdominal hysterectomy]. To compare the analgesic efficacy of tramadol to that of ketorolac trometamol administered intravenously and at fixed times over the 24 hours after abdominal hysterectomy.This controlled, double blind, randomized clinical trial enrolled 76 women undergoing abdominal hysterectomies. Two treatment groups were formed: the TRA (Tramadol) group received 100 mg and the KET

2000 Revista española de anestesiología y reanimación Controlled trial quality: uncertain

7578. Comparison of ketorolac with morphine for intra-operative analgesia in patients undergoing total abdominal hysterectomy. (Abstract)

Comparison of ketorolac with morphine for intra-operative analgesia in patients undergoing total abdominal hysterectomy. To compare ketorolac 0.35 mg x kg(-1) with morphine 0.1 mg x kg(-1) for hemodynamic stability, efficacy of analgesia and incidence of side effects in patients undergoing elective total abdominal hysterectomy.Fifty ASA I and II patients, were enrolled in a prospective, randomized and double blind study. They were divided in two equal groups. Group K received Inj. Ketorolac (...) arterial pressure in ketorolac group (K) as compared to baseline values at points of endotracheal intubation and surgical incision. Patients in Morphine group (M) showed a significant increase in heart rate only. There was no statistically significant difference between the two groups for supplemental analgesia requirement intraoperatively and postoperatively. Complications seen with group K were increased surgical wound bleeding in 2 patients (8%), nausea and vomiting in 4 patients (16%) while

2003 JPMA. The Journal of the Pakistan Medical Association Controlled trial quality: uncertain

7579. The effect of previous abdominal surgery on urological laparoscopy. (Abstract)

a history of abdominal surgery at the same anatomical region and 229 (33%) had a history of abdominal surgery at a different region. Overall previous abdominal surgery of any type was associated with female gender, higher ASA classification, increased age and an increased rate of perioperative transfusion (p = 0.0001). A history of surgery at the same site was associated with increased operative time (p = 0.03) and increased hospital stay (p = 0.02). Differences in operative blood loss (p = 0.3 (...) The effect of previous abdominal surgery on urological laparoscopy. Abdominal surgery causes adhesions that may render subsequent laparoscopic access and dissection problematic. We determined the effect of previous surgery on the operative outcome in a large series of patients undergoing urological laparoscopy.The records of 700 consecutive laparoscopic procedures performed at a single institution from 1995 to 2001 were reviewed. Patient gender, American Society of Anesthesiologists (ASA

2002 Journal of Urology

7580. Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies

(UGIC) associated with aspirin use, and to evaluate the influence of dose and formulation of aspirin as well as the effect of study design. Searching MEDLINE was searched from 1990 to February 2001. The search terms used were 'anti-inflammatory nonsteroidal agents' (both overall and aspirin), 'adverse effects', and 'toxicity' combined with 'peptic ulcer', 'stomach ulcer', 'duodenal ulcer', or 'gastrointestinal diseases' (including haemorrhage and perforation). The references of previous reviews were (...) Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies Garcia Rodriguez L A, Hernandez-Diaz S, de Abajo F J Authors' objectives To systematically review the literature on serious upper gastrointestinal complications

2001 DARE.

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