Risk of Upper Gastrointestinal Hemorrhage in Warfarin Users Treated
With Nonselective NSAIDs or COX-2 Inhibitors
Marisa Battistella, BScPhm, PharmD; Muhammad M. Mamdami, PharmD, MA,
MPH; David N. Juurlink, MD, PhD; Linda Rabeneck, MD, MPH; Andreas
Laupacis, MD, MSc
Arch Intern Med. 2005;165:189-192.
Background Little is known about the risk of upper gastrointestinal
(GI) hemorrhage during the concomitant use of warfarin and selective
cyclooxygenase (COX)-2 inhibitors. We examined the association between
the concomitant use of warfarin and nonselective nonsteroidal
anti-inflammatory drugs (NSAIDs) or selective COX-2 inhibitors in older
adults hospitalized for upper GI hemorrhage.
Methods This nested case-control analysis of multiple linked health
care databases conducted over 1 year identified a cohort of patients in
Ontario, Canada, who were older than 66 years and continuously
prescribed warfarin. Case patients were those admitted to the hospital
with upper GI hemorrhage while taking warfarin. We compared their
prescription records prior to hospitalization with those of age- and
***-matched controls who were also receiving warfarin (the control-case
ratio was 4:1). Odds ratios (ORs) for the risk of hospitalization for
upper GI hemorrhage while concomitantly using warfarin and celecoxib,
rofecoxib, or nonselective NSAIDs were determined.
Results During the study period, we identified 98 821 elderly patients
continuously receiving warfarin. Of those, 361 (0.3%) were admitted to
the hospital with upper GI hemorrhage. After adjusting for other
potential confounders, case patients were significantly more likely to
be also taking nonselective NSAIDs (OR, 1.9; 95% confidence interval
[CI], 1.4-3.7), celecoxib (OR, 1.7; 95% CI, 1.2-3.6), or rofecoxib (OR,
2.4; 95% CI, 1.7-3.6) prior to hospitalization relative to controls.
Conclusions Patients taking warfarin concomitantly with selective
COX-2 inhibitors have an increased risk of hospitalization for upper GI
hemorrhage. The risk appears similar to that of patients simultaneously
taking warfarin and nonselective NSAIDs.
Author Affiliations: University Health Network (Dr Battistella);
Departments of Pharmacy (Dr Mamdami) and Medicine (Drs Mamdami,
Juurlink, and Rabeneck), University of Toronto; Institute for Clinical
Evaluative Sciences (Drs Juurlink, Rabeneck, and Laupacis); and
Clinical Epidemiology and Healthcare Research Program (Dr Juurlink),
Toronto, Ontario.
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http://archinte.ama-assn.org/cgi/content/abstract/165/2/189?etoc
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