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Nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with an increased risk of upper gastrointestinal bleeding. Multiple strategies to reduce this risk have been proposed, including cotherapy with a prostaglandin analogue (misoprostol), acid reduction with a proton-pump inhibitor (PPI), and use of a cyclooxygenase (COX)-2–selective NSAID. Although each of these approaches has been independently demonstrated to decrease bleeding, their relative efficacy, when used alone or in combination, is poorly understood.
To address this issue, investigators in Canada performed a population-based, matched case-control study. Using a Manitoba-based data repository, they identified 1382 individuals who had used NSAIDs (nonselective or …