This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (38)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in this journal  Topic Collections  • Thrombolysis  • Cardiovascular System  • Adverse Effects  • Gastroenterology, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

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 sex-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.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLES

Coxibs, Science, and the Public Trust
Daniel H. Solomon and Jerry Avorn
Arch Intern Med. 2005;165(2):158-160.
EXTRACT | FULL TEXT  

The Effects of Cyclooxygenase-2 Inhibitors and Nonsteroidal Anti-inflammatory Therapy on 24-Hour Blood Pressure in Patients With Hypertension, Osteoarthritis, and Type 2 Diabetes Mellitus
James R. Sowers, William B. White, Bertram Pitt, Andrew Whelton, Lee S. Simon, Nathaniel Winer, Alan Kivitz, Hein van Ingen, Thomas Brabant, John G. Fort, and for the Celecoxib Rofecoxib Efficacy and Safety in Comorbidities Evaluation Trial (CRESCENT) Investigators
Arch Intern Med. 2005;165(2):161-168.
ABSTRACT | FULL TEXT  

National Trends in Cyclooxygenase-2 Inhibitor Use Since Market Release: Nonselective Diffusion of a Selectively Cost-effective Innovation
Carolanne Dai, Randall S. Stafford, and G. Caleb Alexander
Arch Intern Med. 2005;165(2):171-177.
ABSTRACT | FULL TEXT  

Selective Cyclooxygenase-2 Inhibition and Cardiovascular Effects: An Observational Study of a Medicaid Population
Fadia T. Shaya, Steven W. Blume, Christopher M. Blanchette, Matthew R. Weir, and C. Daniel Mullins
Arch Intern Med. 2005;165(2):181-186.
ABSTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Gastrointestinal Safety of Nonsteroidal Antiinflammatory Drugs and Selective Cyclooxygenase-2 Inhibitors in Patients on Warfarin
Cheetham et al.
The Annals of Pharmacotherapy 2009;43:1765-1773.
ABSTRACT | FULL TEXT  

A population-based study of the drug interaction between proton pump inhibitors and clopidogrel
Juurlink et al.
CMAJ 2009;180:713-718.
ABSTRACT | FULL TEXT  

Pharmacology and Management of the Vitamin K Antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Ansell et al.
Chest 2008;133:160S-198S.
ABSTRACT | FULL TEXT  

Hemorrhagic Complications of Anticoagulant and Thrombolytic Treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Schulman et al.
Chest 2008;133:257S-298S.
ABSTRACT | FULL TEXT  

Increased Bleeding Risk With Concurrent Use of Selective Serotonin Reuptake Inhibitors and Coumarins
Schalekamp et al.
Arch Intern Med 2008;168:180-185.
ABSTRACT | FULL TEXT  

An Evidence-Based Update on Nonsteroidal Anti-Inflammatory Drugs
Ong et al.
Clin Med Res 2007;5:19-34.
ABSTRACT | FULL TEXT  

Treatment of rheumatoid arthritis
Gaffo et al.
Am J Health Syst Pharm 2006;63:2451-2465.
ABSTRACT | FULL TEXT  

Risks versus benefits of cyclooxygenase-2-selective nonsteroidal antiinflammatory drugs.
Chaiamnuay et al.
Am J Health Syst Pharm 2006;63:1837-1851.
ABSTRACT | FULL TEXT  

Does Celecoxib Potentiate the Anticoagulant Effect of Warfarin? A Randomized, Double-Blind, Controlled Trial
Dentali et al.
The Annals of Pharmacotherapy 2006;40:1241-1247.
ABSTRACT | FULL TEXT  

Warfarin, Coxibs, and Risk for GI Bleeding
JWatch Gastroenterology 2005;2005:7-7.
FULL TEXT  

More Data on COX-2 Inhibitors
JWatch General 2005;2005:2-2.
FULL TEXT