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Patients at high risk for gastrointestinal (GI) bleeding sometimes have compelling indications for nonsteroidal anti-inflammatory drugs (NSAIDs). To determine which NSAIDs confer the most GI risk, researchers performed a meta-analysis of nine studies (2 cohort and 7 case-control), published between 2000 and 2008.
The overall relative risk for upper GI bleeding or perforation was 4.5 for NSAID users compared with nonusers. Drugs associated with the lowest risks were the selective cyclooxygenase (COX)-2 inhibitors (celecoxib [Celebrex; relative risk, 1.4] and rofecoxib [Vioxx; RR, 2.1]) and ibuprofen (RR, 2.7). Drugs associated with roughly average risks included diclofenac (RR, 4.0), meloxicam (RR, 4.2), indomethacin (RR, 5.4), naproxen (RR, …