Gastrointestinal toxicities associated with NSAIDs:
(1) dyspepsia
(2) ulcer or perforation
(3) GI bleeding
Risk factors for serious gastrointestinal toxicity in patients taking NSAIDs:
(1) advanced age (linear increase in risk)
(2) high doses of NSAIDs, including the use of more than 1 NSAID
(3) shorter duration of therapy
(4) history of peptic ulcer disease or of gastrointestinal bleeding
(5) serious systemic disorder
(6) concomitant corticosteroid use
(7) concomitant anticoagulant therapy
Patients with risk factors for gastrointestinal toxicity may benefit from:
(1) use of a reduced dose
(2) closer monitoring
(3) patient education on warning signs
(4) use of medications to protect the gastrointestinal mucosa such as proton-pump inhibitors
Notes on spreadsheet implementation:
(1) Age >= 75 is scored 2, >= 65 is scored 1, else 0.
(2) A total dose that is very high is scored 2, high is scored 1, else 0.
(3) Comorbid conditions: 1 or more serious is scored 1, 2 or more moderate conditions are scored 1, else 0.
