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GI Risk Calculator, a Tool to Help Physicians to Decide Prescription in Clinical Practice
receiving ASA or placebo, and observational studies of patients taking low-dose ASA. Studies were excluded if any of the following applied: ASA dose >325 mg/day, ASA dose not reported, or all participants given concomitant gastroprotective therapy or Helicobacter pylori eradication therapy. Results. Searches identified 3013 studies, 15 of which were eligible for inclusion. The most commonly reported risk factor for UGIB in low-dose ASA users was a history of peptic ulcer disease (see Figure), which was reported in six studies (n = 3353). Five of the six studies reported relative risks (RRs) or odds ratios (ORs) of 3.1-6.5 when assessing this relationship, while the sixth reported a much higher OR of 15.2 (95% confidence interval [CI]: 3.8-60.1). Other factors significantly and consistently associated with the risk of UGIB in users of low-dose ASA were: current H. pylori infection (1 study; OR: 4.69; 95% CI: 2.02-10.91), concomitant calcium channel blocker use (1 study; OR: 2.53; 95% CI: 1.255.14), concomitant clopidogrel use (1 study; RR: 1.90; 95% CI: 1.12-3.22), increasing ASA dose (1 study; RR: 1.8; 95% CI: 1.5-6.5), and a history of dyspepsia (1 study; RR: 1.77; 95% CI: 1.20-2.61). Three studies found that proton pump inhibitor (PPI) use was associated with a significant reduction in the risk of UGIB in users of low-dose ASA (OR: 0.02, OR: 0.086 and RR: 0.56). Conclusions. Relatively few studies have examined potential risk factors for UGIB in users of low-dose ASA. The studies that have been performed show that the risk of UGIB is increased in low-dose ASA users who have a history of peptic ulcer disease, H. pylori infection or dyspepsia, or who are also taking calcium channel blockers or clopidogrel. Increasing ASA dose is also associated with an increased risk of UGIB. In contrast, patients taking PPIs alongside their low-dose ASA have a reduced risk of UGIB.
AGA Abstracts
infection who have prior ulcer bleeding, the long-term risk of recurrent ulcer bleeding with ASA use is not significantly different from that of average-risk ASA users. Drug exposure (patient-years) and primary outcome (Ulcer bleeding) in the two cohorts according to drugs combinations
IRR, incidence rate ratio; CI, confidence interval. 1053 Aspirin CV/GI Risk Calculator, a Tool to Help Physicians to Decide Prescription in Clinical Practice Angel Lanas, Mónica Polo-Tomás, Ruben Casado-Arroyo Background: The cardiovascular (CV) benefits of low-dose aspirin (LDA) are offset by its association with upper gastrointestinal complications (UGIC), which is variable and depends on the presence of risk factors. In some patients the GI risk of LDA may overcome the CV benefits; co-therapy with PPI has been recommended for at-risk patients to reduce UGIC. However, the assessment of both GI and CV risks and the benefits of LDA for any individual patient may be difficult in clinical practice. Aim: To develop a tool to estimate the CV and GI risks for any individual patient and to facilitate the clinical decision process. Methods: Based on the most updated publications we have constructed risk ratios estimations and incidence of CV and UGIC events according to the presence of different risk factors. For CV risks we have used Framingham's 10 year-risk estimations (Wilson, D'Agostino, Levy et al. Circulation 1998) and assumed a 15-20% CV risk reduction with ASA depending on basal risk. Clopidogrel on top of LDA reduced that risk a further 8%. For UGIC we assumed a baseline incidence of 1 case per 1000-persons-year and considered the following risk factors (age, male sex, complicated ulcer history, uncomplicated ulcer history, dyspepsia and concomitant use of NSAID use, warfarin/dicumarinics or clopidogrel). LDA increased UGIC risk by a factor of 2 and estimated a 60% GI risk reduction with PPI co-therapy and another 60% with H. pylori eradication in patients with peptic ulcer history. Access to this CV/GI risk calculator is available at http://servidor1.azormultimedia.es/calculadora/index.php Results: Table 1 contains 4 examples of a 70 years old male with different GI and CV risks where the number of UGIC events associated with LDA use overcome the CV benefits, as well as the effects of PPI co-therapy or HP eradication. Many other cases can be tested online. Conclusions: There are many clinical conditions where the number of UGIC induced by LDA exceeds the number of CV events prevented. An ASA CV/GI risk calculator for use in clinical practice should help and guide physicians to choose the most appropriate prescriptions. CV/GI events saved/ induced by LDA and co-therapy in 10 years time
Figure. Number of studies reporting various risk factors for upper gastrointestinal bleeding in users of low-dose acetylsalicylic acid. 1055 International, Prospective, Observational, Multicenter Registry on the Management of Acute Diarrhea in Children (REMAD) Francisco Guarner, Margarita Murrieta-Aguttes, Georgette Daoud, Hugo Laignelet, Alejandra Consuelo
* per 1000 patients-year
Acute diarrhea is a leading cause of morbidity and mortality in children. Prompt and appropriate management prevents complications and reduces health risks. The level of knowledge, use, and availability of therapies to successfully manage acute diarrhea in normal practice is not well known. To this aim, a prospective observational study was carried out in 5 countries: Colombia (22 sites), Guatemala (15 sites), Mexico (22 sites), Venezuela (17 sites), and Egypt (24 sites). Target population: infants/children (6 mo to 6 y of age) presenting with community acquired acute diarrhea at onset. Chronic disease (IBD/IBS), underlying severe malnutrition and immuno-deficiency were excluded. The study consisted of 2 visits, entry and longitudinal visit at 15±1 d. Data retrieval: demography, medical history, physical examination, available laboratory tests, therapeutic measures, incidence of complications, and diarrhea status at end of study (main outcome measure). Results: 1439 children were included (Colombia 258, Guatemala 309, Mexico 300, Venezuela 266, and Egypt 306) during a 12-month enrollment period and 1388 completed the study. At entry, 53.4%
1054 Risk Factors for Upper Gastrointestinal Bleeding in Patients Using Low-Dose Acetylsalicylic Acid: A Systematic Literature Analysis Ernst J. Kuipers, Catherine Hill Introduction. Low-dose acetylsalicylic acid (ASA) is recommended for secondary prevention of cardiovascular events. However, its use is also associated with an increased risk of upper gastrointestinal bleeding (UGIB). This study aimed to assess systematically the risk factors for UGIB in users of low-dose ASA. Methods. A systematic review of PubMed was performed (to August 2010) to identify randomized controlled trials reporting UGIB in individuals
AGA Abstracts
S-174
AGA Abstracts
infection who have prior ulcer bleeding, the long-term risk of recurrent ulcer bleeding with ASA use is not significantly different from that of average-risk ASA users. Drug exposure (patient-years) and primary outcome (Ulcer bleeding) in the two cohorts according to drugs combinations
IRR, incidence rate ratio; CI, confidence interval. 1053 Aspirin CV/GI Risk Calculator, a Tool to Help Physicians to Decide Prescription in Clinical Practice Angel Lanas, Mónica Polo-Tomás, Ruben Casado-Arroyo Background: The cardiovascular (CV) benefits of low-dose aspirin (LDA) are offset by its association with upper gastrointestinal complications (UGIC), which is variable and depends on the presence of risk factors. In some patients the GI risk of LDA may overcome the CV benefits; co-therapy with PPI has been recommended for at-risk patients to reduce UGIC. However, the assessment of both GI and CV risks and the benefits of LDA for any individual patient may be difficult in clinical practice. Aim: To develop a tool to estimate the CV and GI risks for any individual patient and to facilitate the clinical decision process. Methods: Based on the most updated publications we have constructed risk ratios estimations and incidence of CV and UGIC events according to the presence of different risk factors. For CV risks we have used Framingham's 10 year-risk estimations (Wilson, D'Agostino, Levy et al. Circulation 1998) and assumed a 15-20% CV risk reduction with ASA depending on basal risk. Clopidogrel on top of LDA reduced that risk a further 8%. For UGIC we assumed a baseline incidence of 1 case per 1000-persons-year and considered the following risk factors (age, male sex, complicated ulcer history, uncomplicated ulcer history, dyspepsia and concomitant use of NSAID use, warfarin/dicumarinics or clopidogrel). LDA increased UGIC risk by a factor of 2 and estimated a 60% GI risk reduction with PPI co-therapy and another 60% with H. pylori eradication in patients with peptic ulcer history. Access to this CV/GI risk calculator is available at http://servidor1.azormultimedia.es/calculadora/index.php Results: Table 1 contains 4 examples of a 70 years old male with different GI and CV risks where the number of UGIC events associated with LDA use overcome the CV benefits, as well as the effects of PPI co-therapy or HP eradication. Many other cases can be tested online. Conclusions: There are many clinical conditions where the number of UGIC induced by LDA exceeds the number of CV events prevented. An ASA CV/GI risk calculator for use in clinical practice should help and guide physicians to choose the most appropriate prescriptions. CV/GI events saved/ induced by LDA and co-therapy in 10 years time
Figure. Number of studies reporting various risk factors for upper gastrointestinal bleeding in users of low-dose acetylsalicylic acid. 1055 International, Prospective, Observational, Multicenter Registry on the Management of Acute Diarrhea in Children (REMAD) Francisco Guarner, Margarita Murrieta-Aguttes, Georgette Daoud, Hugo Laignelet, Alejandra Consuelo
* per 1000 patients-year
Acute diarrhea is a leading cause of morbidity and mortality in children. Prompt and appropriate management prevents complications and reduces health risks. The level of knowledge, use, and availability of therapies to successfully manage acute diarrhea in normal practice is not well known. To this aim, a prospective observational study was carried out in 5 countries: Colombia (22 sites), Guatemala (15 sites), Mexico (22 sites), Venezuela (17 sites), and Egypt (24 sites). Target population: infants/children (6 mo to 6 y of age) presenting with community acquired acute diarrhea at onset. Chronic disease (IBD/IBS), underlying severe malnutrition and immuno-deficiency were excluded. The study consisted of 2 visits, entry and longitudinal visit at 15±1 d. Data retrieval: demography, medical history, physical examination, available laboratory tests, therapeutic measures, incidence of complications, and diarrhea status at end of study (main outcome measure). Results: 1439 children were included (Colombia 258, Guatemala 309, Mexico 300, Venezuela 266, and Egypt 306) during a 12-month enrollment period and 1388 completed the study. At entry, 53.4%
1054 Risk Factors for Upper Gastrointestinal Bleeding in Patients Using Low-Dose Acetylsalicylic Acid: A Systematic Literature Analysis Ernst J. Kuipers, Catherine Hill Introduction. Low-dose acetylsalicylic acid (ASA) is recommended for secondary prevention of cardiovascular events. However, its use is also associated with an increased risk of upper gastrointestinal bleeding (UGIB). This study aimed to assess systematically the risk factors for UGIB in users of low-dose ASA. Methods. A systematic review of PubMed was performed (to August 2010) to identify randomized controlled trials reporting UGIB in individuals
AGA Abstracts
S-174