Dave, this argument between you and Coby has been entertaining. Here's my take.
NSAID's definitely DO cause deaths from GI hemorrhage. It's more LIKELY to occur in patients who are sick and debilitated, but it can occur in completely healthy individuals. When it occurs, it's frequently abrupt and massive. The mechanism for the bleeding is not acidity (as Coby stated) because the normally functioning stomach is a highly acidic environment, gastric juice normally has a pH of 1. The main problem is COX-1 receptor inhibition, which decreases mucosal levels of prostacyclin. Prostacyclin protects the stomach lining from acidity. Most people can handle the decrease in prostacyclin levels, but some can't and of the ones who can't, some will bleed. This is where the market for COX-2 inhibitors comes from, they are selective for the receptors that cause inflammation, while not affecting the receptors in the stomach that if inhibited may produce NSAID-induced gastropathy and bleeding. As a result, this class of NSAID (COX-2 inhibitors) has become phenomenally popular (includes Merck's Vioxx and Pharmacia's Celebrex.
The question is, knowing this, are the drugs ( non-selective NSAID's) too dangerous to use widely? The answer, IMO is "no". The benefits of aspirin are well known, it's a drug that's been widely available for over 120 years. It's effects as a platelet inhibitor are extremely useful in prevention of heart attacks and strokes. Moreover, its dirt cheap which we tend to forget in this era of booming medical costs. As an occassional treatment for minor pain, its effective. It's an excellent anti-pyretic. People with ulcers or history of GI bleeding, other bleeding disorders, and aspirin allergy or sensitivity should avoid it. It's not a great choice for CHRONIC arthritis because of longer term concerns with bleeding and need for dose monitoring when used at the higher dose levels. Nonetheless, aspirin and the non-selective NSAID's still have their role. |
