Sopena F, Lanas A
Department of Gastroenterology University Hospital Lozano Blesa Zaragoza, Spain.
Curr Pharm Des. 2007;13(22):2248-60. doi: 10.2174/138161207781368837.
NSAIDs are widely used all over the world. NSAID use is rising due to increasing availability without a prescription, use of aspirin for prevention of thrombotic disorders and the ageing population. Aspirin is used as an analgesic drug in many countries, but the main current indication is low-dose aspirin for the prevention of cardiovascular events. However, NSAIDs and aspirin use account for approximately 20-25% of all reported drug adverse events. Most of those are gastrointestinal including dyspepsia, hemorrhage, perforation and even death. The COX-2- selective inhibitors (coxibs) have demonstrated equivalent efficacy to nonspecific NSAIDs in the management of arthritis and pain but have less gastrointestinal adverse events, although coxibs and probably all NSAIDs, significantly increase risk of serious thromboembolic events. Concomitant use of low-dose aspirin is present in more than 20% of all patients taking either NSAIDs or coxibs, thus increasing the risk of gastrointestinal side effects. Furthermore, at present, it is not known whether aspirin decreases the cardiovascular risks of COX-2 inhibitors or NSAIDs. Appropriate strategies for gastrointestinal risk reduction with NSAIDs and aspirin must consider the overall health status of our patients including the presence of cardiovascular and gastrointestinal risk factors. Use of the lowest possible dose of these drugs, gastroprotectants, especially proton pump inhibitors and Helicobacter pylori eradication will reduce the risk of gastrointestinal side effects in patients taking low-dose aspirin and NSAIDs or coxibs.
非甾体抗炎药在全球广泛使用。由于无需处方即可获得的药物增多、阿司匹林用于预防血栓形成性疾病以及人口老龄化，非甾体抗炎药的使用正在增加。在许多国家，阿司匹林被用作镇痛药，但目前的主要适应证是低剂量阿司匹林用于预防心血管事件。然而，非甾体抗炎药和阿司匹林的使用约占所有报告的药物不良事件的20% - 25%。其中大多数是胃肠道不良反应，包括消化不良、出血、穿孔甚至死亡。COX - 2选择性抑制剂（昔布类药物）在治疗关节炎和疼痛方面已显示出与非特异性非甾体抗炎药等效的疗效，但胃肠道不良事件较少，尽管昔布类药物以及可能所有的非甾体抗炎药都会显著增加严重血栓栓塞事件的风险。超过20%服用非甾体抗炎药或昔布类药物的患者同时使用低剂量阿司匹林，从而增加了胃肠道副作用的风险。此外，目前尚不清楚阿司匹林是否能降低COX - 2抑制剂或非甾体抗炎药的心血管风险。使用非甾体抗炎药和阿司匹林降低胃肠道风险的适当策略必须考虑我们患者的整体健康状况，包括心血管和胃肠道危险因素的存在。使用尽可能低的剂量的这些药物、胃黏膜保护剂，尤其是质子泵抑制剂以及根除幽门螺杆菌将降低服用低剂量阿司匹林、非甾体抗炎药或昔布类药物的患者出现胃肠道副作用的风险。
