Coxibs plus PPIs for Patients with High Risk for Bleeding

Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with high risk for gastrointestinal bleeding. This risk can be lowered by using a cyclooxygenase-2–selective NSAID (coxib) or by adding a proton-pump inhibitor (PPI) to nonselective NSAID therapy. Recent guidelines recommend that these approaches be used for patients who require NSAIDs but have risk factors for NSAID-associated ulcers. However, neither approach completely eliminates bleeding risk. An alternative strategy is to prescribe cotherapy with a coxib and a PPI, but this approach has not been tested in randomized trials.

To address this issue, investigators recruited 441 consecutive high-risk patients with nonselective-NSAID–associated ulcer bleeding who were admitted to a …