Expert consensus document on the appropriate use of non-steroidal antiinflammatory drugs and aspirin

Overview

Aim:
General practitioners need support in their everyday decision-making in the use of non-steroidal antiinflammatory drug (NSAID) and aspirin (ASA) in patients with varying degrees of gastrointestinal and cardiovascular risk. The aim of this document is to reflect the current scientific knowledge and experts’ panel consensus in recommendation for daily practice.

Method:
The panel comprised 13 physicians (five gastroenterologists, four rheumatologists and four general practitioners), practising both in academic and non-academic posts. The relevant evidence review on issues concerning the indication, risks and benefits of NSAIDs and ASA was performed and presented by academic panelists. As a method of final synthesing individual judgements the nominal group technique for consensus development was used. The panel rated on 34 theses, prepared by general practitioners and reflecting the clinical scenarios from general practice.

Results:
The panel agreed on 26 of the 34 theses (76%).

According to consensus patient with one or more risk factor of GI event, other than peptic ulcer or bleeding, requiring short term NSAID should have preferential NSAID or non-selective NSAID and proton pump inhibitor (PPI). The same patient on long term medication should have PPI as co-prescription. In patients with peptic ulcer or bleeding in history antisecretory treatment was rated as appropriate both in short and long term treatment either with non-selective, preferential or selective NSAID. Patient with one or more risk factors using ASA 100 mg, ASA and NSAID or warfarin and NSAID should get PPI, e.g. omeprazol, as prophylaxis.

Conclusions:
The evidence based medicine combined with consensual process still does not solve all doubts and uncertainty in clinical practice but the results contribute to existing guidelines for GPs and identify areas, where ongoing research is expected. Individual risk profile assessment and consideration of gastroenterological, cardiological and renal complications is necessary in patients referred for NSAID treatment.

Key words:
non-steroidal antiinflammatory drugs – aspirin – gastropathy – general practitioner – interdisciplinary consensus.