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Analgesics for Osteoarthritis—An Update

Slide: 21 of 32

Factors Affecting Outcomes: Concomitant Medication Use

A systematic review found that concomitant use of low-dose aspirin increased the rate of endoscopic ulcers by about 6 percent in patients randomized to celecoxib (4.2% without aspirin and 9.9% with aspirin) or those randomized to a nonselective NSAID (18% and 24%, respectively).
Strength of evidence: High

Concomitant use of low-dose aspirin eliminated the GI benefits of COX-2 selective NSAIDs, resulting in risks similar to those for nonselective NSAIDs. However, the addition of a PPI may reduce the risk of GI adverse effects associated with the use of either celecoxib or nonselective NSAIDs plus low-dose aspirin.
Strength of evidence: High

Concomitant use of anticoagulants and nonselective NSAIDs increased the risk of GI bleeding three-fold to six-fold when compared with anticoagulant use without NSAIDs.
Strength of evidence: Moderate