Faecal blood loss with aspirin, nonsteroidal anti-inflammatory drugs and cyclo-oxygenase-2 selective inhibitors: systematic review of randomized trials using autologous chromium-labelled erythrocytesReport as inadecuate




Faecal blood loss with aspirin, nonsteroidal anti-inflammatory drugs and cyclo-oxygenase-2 selective inhibitors: systematic review of randomized trials using autologous chromium-labelled erythrocytes - Download this document for free, or read online. Document in PDF available to download.

Arthritis Research and Therapy

, 10:R7

First Online: 17 January 2008Received: 20 July 2007Revised: 10 October 2007Accepted: 17 January 2008

Abstract

IntroductionFaecal blood loss has been measured using autologous erythrocytes labelled with radioactive chromium for several decades, using generally similar methods. We conducted a systematic review of studies employing this technology to determine the degree of blood loss associated with use of aspirin, nonsteroidal anti-inflammatory drugs NSAIDs and cyclo-oxygenase-2 selective inhibitors coxibs.

MethodsA systematic search of PubMed and the Cochrane Library to December 2006 was conducted to identify randomized trials in which treatment with aspirin, NSAIDs, or coxibs was continued for at least 7 days, and with at least 7 days of washout for crossover trials. Rates of faecal blood loss associated with these agents were determined in the randomized trials identified. Comparators were placebo, active, or no treatment. Outcomes of interest were mean daily faecal blood loss, and the number or proportion of individuals recording faecal blood above 5 ml-day and above 10 ml-day.

ResultsForty-five reports of 47 trials were included, including 1,162 individuals, mostly healthy volunteers and predominantly young men. Only 136 patients as opposed to healthy volunteers; 12% were included, and these were mostly older people with an arthritic condition. Most NSAIDs and low-dose 325 mg aspirin resulted in a small average increase in faecal blood loss of 1 to 2 ml-day from about 0.5 ml-day at baseline. Aspirin at full anti-inflammatory doses resulted in much higher average levels of blood loss of about 5 ml-day. Some individuals lost much more blood than average, at least for some of the time, with 5% of those taking NSAIDs having daily blood loss of 5 ml or more and 1% having daily blood loss of 10 ml or more; rates of daily blood loss of 5 ml-day or 10 ml-day were 31% and 10%, respectively, for aspirin at daily doses of 1,800 mg or greater.

ConclusionAt baseline, or with placebo, faecal blood loss is measured at 1 ml-day or below. With low-dose aspirin and some NSAIDs, average values may be two to four times this, and anti-inflammatory doses of aspirin result in much higher average losses. A small proportion of individuals respond to aspirin or NSAIDs with much higher faecal blood loss of above 5 ml-day or 10 ml-day. There are significant limitations regarding the quality and validity of reporting of these studies, such as limited size and inclusion of inappropriate participants. The potential for blood loss and consequent anaemia requires more study.

Abbreviationscoxib= cyclo-oxygenase-2 selective inhibitor

NSAID= nonsteroidal anti-inflammatory drug.

Electronic supplementary materialThe online version of this article doi:10.1186-ar2355 contains supplementary material, which is available to authorized users.

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Author: R Andrew Moore - Sheena Derry - Henry J McQuay

Source: https://link.springer.com/







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