ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2007
Drug drug interactions between antithrombotic medications and the risk of gastrointestinal bleeding.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 72 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Data-driven Quality Improvement in Primary Care: Cluster Randomised Controlled Trial to Test the Effectiveness of a Multifaceted Intervention in Reducing High Risk Prescribing of Non-steroidal Anti-inflammatory Drugs and Antiplatelet Agents
Aspirin Versus Aspirin + ClopidogRel as Antithrombotic Treatment Following Transcatheter Aortic Valve Implantation With the Edwards SAPIEN XT Valve. A Randomized Pilot Study (the ARTE Trial)
Aspirin Versus Aspirin + ClopidogRel as Antithrombotic Treatment Following Transcatheter Aortic Valve Implantation With the Edwards Valve. A Randomized Study (the ARTE Trial)
Who cites it
72 citing papers in PubMed, 4 syntheses or guidelines pooled it, 245 citations in OpenAlex.
- Antithrombotic management after aortic valve replacement with biological prosthesis: a meta-analysis.Journal of cardiothoracic surgery · 2024Pooled it
- Risk of bleeding with concomitant use of oral anticoagulants and aspirin: A systematic review and meta-analysis.American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists · 2024Pooled it
- Risk factors for anticoagulant-associated gastrointestinal hemorrhage: a systematic review and meta-analysis.The Korean journal of internal medicine · 2024Pooled it
- Guideline
- Lack of effect of Imrecoxib, an innovative and moderate COX-2 inhibitor, on pharmacokinetics and pharmacodynamics of warfarin in healthy volunteers.Scientific reports · 2019Trial
- Effects of clopidogrel added to aspirin in patients with recent lacunar stroke.The New England journal of medicine · 2012Trial
- Trial
- Randomized clinical trial of a customized electronic alert requiring an affirmative response compared to a control group receiving a commercial passive CPOE alert: NSAID--warfarin co-prescribing as a test case.Journal of the American Medical Informatics Association : JAMIATrial
- Assessment of the Prognostic Performance of the Oakland Score in Lower Gastrointestinal Bleeding: A Retrospective Cohort Study.Diagnostics (Basel, Switzerland) · 2026Article
- Timing of anticoagulation restart after serious bleeding in atrial fibrillation.Heart (British Cardiac Society) · 2026Article
- Rivaroxaban in Chinese children with giant coronary artery aneurysms after Kawasaki disease.Research and practice in thrombosis and haemostasis · 2025Article
- To bleed or not to bleed: Observing risk of concomitant nonsteroidal anti-inflammatory drug and oral anticoagulant use after venous thromboembolism.Journal of vascular surgery. Venous and lymphatic disorders · 2025Article
- Article
- A Case of Unexplained Warfarin Resistance: A Case Report and Literature Review.The journal of Tehran Heart Center · 2023Article
- Edible Mushrooms as Source of Fibrin(ogen)olytic Enzymes: Comparison between Four Cultivated Species.Molecules (Basel, Switzerland) · 2022Article
- Shared Decision-Making for Drug-Drug Interactions: Formative Evaluation of an Anticoagulant Drug Interaction.JMIR formative research · 2022Article
- A Shared Decision-making Tool for Drug Interactions Between Warfarin and Nonsteroidal Anti-inflammatory Drugs: Design and Usability Study.JMIR human factors · 2021Article
- Drug-drug Interactions of Antithrombotic Medications During Treatment of COVID-19.Turkish journal of pharmaceutical sciences · 2021Article
- Effect of DLBS1033 on Functional Outcomes for Patients with Acute Ischemic Stroke: A Randomized Controlled Trial.Stroke research and treatment · 2021Article
- Aspirin as a Potential Geroprotector: Experimental Data and Clinical Evidence.Advances in experimental medicine and biology · 2021Article
12 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAnticoagulants and antiplatelet drugs (e.g., warfarin, clopidogrel and acetylsalicylic acid) are key therapeutic agents in the treatment of cardiovascular diseases. However, drug-drug interactions may lead to a greatly increased risk of gastrointestinal bleeding when these drugs are combined. We assessed whether antithrombotic drug combinations increased the risk of such bleeding in a general practice population.
methodsWe conducted a population-based, retrospective case-control study using records in the United Kingdom General Practice Research Database from 2000 through 2005. Cases were identified as patients over 18 years of age with a first-ever diagnosis of gastrointestinal bleeding. They were matched with controls by physician practice, patient age and index date (date of diagnosis of bleeding). All eligible patients had to have at least 3 years of follow-up data in the database. Drug exposure was considered to be any prescription issued in the 90 days before the index date.
resultsThere were 4028 cases with a diagnosis of gastrointestinal bleeding and 40 171 matched controls. The prescribing of acetylsalicylic acid with either clopidogrel (adjusted rate ratio [RR] 3.90, 95% confidence interval [CI] 2.78-5.47) or warfarin (adjusted RR 6.48, 95% CI 4.25-9.87) was associated with a greater risk of gastrointestinal bleeding than that observed with each drug alone. The same was true when a nonsteroidal anti-inflammatory drug was combined with either clopidogrel (adjusted RR 2.93, 95% CI 1.74-4.93) or warfarin (RR 4.60, 95% CI 2.77-7.64).
interpretationDrug combinations involving antiplatelets and anticoagulants are associated with a high risk of gastrointestinal bleeding beyond that associated with each drug used alone. Physicians should be aware of these risks to better assess their patients' therapeutic risk-benefit profiles.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.