Podcast
Questions and Answers
What is the adjusted risk ratio (RR) for gastrointestinal bleeding associated with the combination of warfarin and acetylsalicylic acid?
What is the adjusted risk ratio (RR) for gastrointestinal bleeding associated with the combination of warfarin and acetylsalicylic acid?
- 2.23 (correct)
- 1.94
- 6.48
- 4.00
Which known risk factor for gastrointestinal bleeding has the highest adjusted risk ratio (RR) listed?
Which known risk factor for gastrointestinal bleeding has the highest adjusted risk ratio (RR) listed?
- Liver failure (correct)
- Heavy alcohol use
- Male sex
- Smoking
What was the primary characteristic of the population studied in the case–control study?
What was the primary characteristic of the population studied in the case–control study?
- Patients with chronic illnesses
- Patients over 18 years with a first-ever diagnosis of gastrointestinal bleeding (correct)
- Adults with a history of gastrointestinal conditions
- Children under 18 years of age
What was the adjusted risk ratio (RR) for patients taking warfarin alone?
What was the adjusted risk ratio (RR) for patients taking warfarin alone?
Which factor has the lowest adjusted risk ratio (RR) associated with an increased risk of gastrointestinal bleeding?
Which factor has the lowest adjusted risk ratio (RR) associated with an increased risk of gastrointestinal bleeding?
How many cases of gastrointestinal bleeding were identified in the study?
How many cases of gastrointestinal bleeding were identified in the study?
Which two drugs were associated with an increased risk of gastrointestinal bleeding?
Which two drugs were associated with an increased risk of gastrointestinal bleeding?
What is the adjusted risk ratio (RR) for gastrointestinal bleeding from heavy alcohol use?
What is the adjusted risk ratio (RR) for gastrointestinal bleeding from heavy alcohol use?
What was the duration of data collection for the study?
What was the duration of data collection for the study?
What is the effect of combining warfarin and acetylsalicylic acid on the risk of gastrointestinal bleeding, as indicated by the adjusted risk ratio?
What is the effect of combining warfarin and acetylsalicylic acid on the risk of gastrointestinal bleeding, as indicated by the adjusted risk ratio?
What criteria were used to match cases and controls in the study?
What criteria were used to match cases and controls in the study?
Among the factors listed, which one solely contributes an adjusted RR of 1.47 for gastrointestinal bleeding?
Among the factors listed, which one solely contributes an adjusted RR of 1.47 for gastrointestinal bleeding?
What does the combination of clopidogrel with a nonsteroidal anti-inflammatory drug (NSAID) indicate in terms of adjusted risk ratio (RR)?
What does the combination of clopidogrel with a nonsteroidal anti-inflammatory drug (NSAID) indicate in terms of adjusted risk ratio (RR)?
What type of database was used for this study?
What type of database was used for this study?
Which of the following statements is true regarding the database used in the research?
Which of the following statements is true regarding the database used in the research?
What was the adjusted rate ratio for the risk of gastrointestinal bleeding associated with the prescribing of warfarin?
What was the adjusted rate ratio for the risk of gastrointestinal bleeding associated with the prescribing of warfarin?
What is the risk associated with combining antiplatelets and anticoagulants?
What is the risk associated with combining antiplatelets and anticoagulants?
What criteria were used to define a case in the study?
What criteria were used to define a case in the study?
What was the adjusted relative risk (RR) when combining a nonsteroidal anti-inflammatory drug with clopidogrel?
What was the adjusted relative risk (RR) when combining a nonsteroidal anti-inflammatory drug with clopidogrel?
What must patients have to be included in the study?
What must patients have to be included in the study?
How many controls were selected for every case in the database?
How many controls were selected for every case in the database?
Which of the following medications was associated with a relative risk of 4.60 when combined with a nonsteroidal anti-inflammatory drug?
Which of the following medications was associated with a relative risk of 4.60 when combined with a nonsteroidal anti-inflammatory drug?
What demographic information was used to match controls in the study?
What demographic information was used to match controls in the study?
What is the primary interpretation regarding drug combinations in this study?
What is the primary interpretation regarding drug combinations in this study?
Which agents are known to pose renal risks alongside cardiac risks?
Which agents are known to pose renal risks alongside cardiac risks?
Which drug is associated with a higher risk of gastrointestinal bleeding compared to cyclooxygenase-2 selective inhibitors?
Which drug is associated with a higher risk of gastrointestinal bleeding compared to cyclooxygenase-2 selective inhibitors?
What should physicians be aware of when prescribing antithrombotic agents?
What should physicians be aware of when prescribing antithrombotic agents?
Which of the following statements about cyclooxygenase-2 selective inhibitors is correct?
Which of the following statements about cyclooxygenase-2 selective inhibitors is correct?
What does the forest plot in Figure 1 represent?
What does the forest plot in Figure 1 represent?
Which group of patients should be especially monitored for gastrointestinal risks?
Which group of patients should be especially monitored for gastrointestinal risks?
What is the role of the contributors mentioned in the content?
What is the role of the contributors mentioned in the content?
Which statement is false regarding the risk assessment of drug interactions?
Which statement is false regarding the risk assessment of drug interactions?
What was the main finding of the study regarding gastrointestinal bleeding?
What was the main finding of the study regarding gastrointestinal bleeding?
How did the estimates of gastrointestinal bleeding in this study compare to those from clinical trials?
How did the estimates of gastrointestinal bleeding in this study compare to those from clinical trials?
What limitation did the study have concerning data collection?
What limitation did the study have concerning data collection?
Where was the study population primarily based?
Where was the study population primarily based?
Which funding organization supported the study?
Which funding organization supported the study?
What distinction is Samy Suissa associated with in this study?
What distinction is Samy Suissa associated with in this study?
What was noted about the monitoring of patients in the study?
What was noted about the monitoring of patients in the study?
Which antithrombotic agent was specifically mentioned in the study?
Which antithrombotic agent was specifically mentioned in the study?
Study Notes
Study Design and Population
- This was a retrospective case-control study using data from the UK General Practice Research Database (2000-2005).
- The study included patients over 18 years old with records containing a first-ever diagnosis of gastrointestinal bleeding.
- Controls were matched to cases based on physician practice, patient age (within ± 2 years), and index date (date of diagnosis of bleeding).
- All eligible patients had at least 3 years of follow-up data in the database.
Key Findings
- Known risk factors for gastrointestinal bleeding (e.g. male sex, heavy alcohol use, smoking, acetaminophen use, and liver failure) were associated with increased risk in the study.
- Combining acetylsalicylic acid (ASA) with clopidogrel or warfarin was associated with a significantly higher risk of gastrointestinal bleeding than either drug alone.
- The combination of ASA with other antithrombotic agents yielded a significant interaction term, indicating an added risk beyond the individual risks of each drug.
- Combining nonsteroidal anti-inflammatory drugs (NSAIDS) with clopidogrel or warfarin also resulted in a significantly higher risk of gastrointestinal bleeding compared to each drug alone.
Drug Combinations and Risk
- Combining acetylsalicylic acid (ASA) with clopidogrel: adjusted rate ratio (RR) 3.90 (95% confidence interval [CI] 2.78–5.47)
- Combining ASA with warfarin: adjusted RR 6.48 (95% CI 4.25–9.87)
- Combining NSAIDS with clopidogrel: adjusted RR 2.93 (95% CI 1.74–4.93)
- Combining NSAIDS with warfarin: adjusted RR 4.60 (95% CI 2.77–7.64)
Interpretation
- These combinations of drugs, particularly those involving antiplatelets and anticoagulants, carry a high risk of gastrointestinal bleeding beyond the risks associated with each drug used individually.
- Physicians should be mindful of these risks when prescribing these combinations and carefully assess their patients' therapeutic risk-benefit profiles.
- The findings may be even more relevant for cyclooxygenase-2 selective inhibitors due to their known cardiac and renal risks.
- Despite lower bleeding risk compared to traditional NSAIDs, the risk of gastrointestinal bleeding associated with cyclooxygenase-2 selective inhibitors may be similar when combined with antithrombotic agents.
- The study is population-based, making the inferences relevant to real-world clinical settings.
- The study's limitation is that it relies on physician records, which may introduce potential biases.
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Description
This quiz explores a retrospective case-control study on gastrointestinal bleeding using the UK General Practice Research Database. Participants over 18 were analyzed based on various known risk factors. The study also investigates the risks associated with drug combinations like ASA and anticoagulants.
