Impact of discontinuing non-steroidal antiinflammatory drugs on long-term recurrence in colonic diverticular bleeding

Table 1 Baseline characteristics of the study cohort (n = 132) n (%)

Characteristic	Value
Mean age (mean ± SD), yr	70 ± 12
Age > 70 yr	70 (53)
Sex, male	87 (66)
Anatomical distribution of diverticula
Right-sided type	42 (32)
Left-sided typ	27 (20)
Bilateral type	63 (48)
Definite diagnosis (stigmata of recent hemorrhage)	23 (17)
Presumptive diagnosis	109 (83)
Transfusion requirement during hospitalization	37 (28)
Mean units of transfused blood per patient1± SD	8.0 ± 6.0
Current drinker	126 (95)
Current smoker	36 (27)
NSAID2 users on admission	41 (27)
Discontinuing NSAID users at discharge	26 (20)
Continuing NSAID users at discharge	15 (11)
Low-dose aspirin2 users on admission	29 (22)
Low-dose aspirin users at discharge	29 (22)
Non-aspirin antiplatelet2 users on admission	27 (21)
Non-aspirin antiplatelet users at discharge	27 (21)
Anticoagulant2 users on admission	9 (6.8)
Anticoagulant users at discharge	9 (6.8)
Acetaminophen users on admission	2 (1.5)
Acetaminophen users at discharge	13 (9.9)
Corticosteroid users on admission	4 (3.0)
Corticosteroid users at discharge	5 (3.3)
Hypertension	83 (63)
Diabetes mellitus	27 (20)
Dyslipidemia	29 (22)
Cardiovascular disease	33 (25)
Cerebrovascular disease	2 (1.5)
Chronic liver disease	5 (3.8)
Hemodialysis	7 (5.3)

¹Analysis of patients who received transfusion.

²Non-selective NSAIDs included loxoprofen, diclofenac, naproxen, etodolac, zaltoprofen, meloxicam, lornoxicam, and celecoxib (n = 3). Distribution type was defined as follows: right-sided, involving the transverse or proximal colon; left-sided, involving the descending or distal colon; or bilateral, involving the entire colon. Low-dose aspirin included enteric-coated aspirin (100 mg) and buffered aspirin (81 mg). Non-aspirin antiplatelet agents included ticlopidine, clopidogrel, cilostazol, dipyridamole, sarpogrelate hydrochloride, ethyl icosapentate, dilazep, limaprost, and beraprost. Anticoagulants included warfarin and dabigatran etexilate. NSAIDs: Non-steroidal anti-inflammatory drugs.

Table 2 Risk factors for rebleeding after discharge on univariate analysis (n = 132)

Factor	Non-rebleeding/rebleeding	Hazard ratio (95%CI)	P
Age > 70 yr	45 (48)/25 (64)	1.6 (0.83-3.1)	0.15
Sex, male	59 (63)/28 (72)	1.1 (0.57-2.3)	0.70
Anatomical distribution of diverticula
Right-sided diverticula	34 (37)/8 (21)	0.49 (0.22-1.1)	0.06
Left-sided diverticula	19 (20)/8 (21)	1.3 (0.60-2.8)	0.51
Bilateral diverticula	40 (43)/23 (59)	1.5 (0.79-2.8)	0.21
Endoscopic procedure	20 (22)/3 (7.7)	0.43 (0.13-1.4)	0.16
Transfusion requirement	25 (27)/12 (31)	1.2 (0.63-2.5)	0.53
Current drinker	90 (97)/36 (92)	0.78 (0.24-2.5)	0.68
Current smoker	26 (28)/10 (26)	0.80 (0.39-1.7)	0.55
NSAID users	4 (4.3)/11 (28)	5.1 (2.5-10)	< 0.01
Low-dose aspirin1 users	20 (22)/9 (23)	0.88 (0.42-1.9)	0.74
Non-aspirin antiplatelet1 users	16 (17)/11 (28)	1.6 (0.78-3.1)	0.21
Anticoagulant1 users	7 (7.5)/2 (5.1)	0.54 (0.13-2.2)	0.38
Acetaminophen users	10 (11)/3 (7.7)	0.72 (0.22-2.3)	0.58
Corticosteroid users	3 (3.2)/2 (5.1)	1.4 (0.35-6.0)	0.61
Hypertension	55 (60)/28 (72)	1.4 (0.69-2.8)	0.35
Diabetes mellitus	22 (24)/5 (13)	0.52 (0.20-1.3)	0.16
Dyslipidemia	20 (22)/9 (23)	0.88 (0.42-1.8)	0.73
Cardiovascular disease	25 (27)/8 (21)	0.55 (0.25-1.2)	0.13
Cerebrovascular disease	1 (1.1)/1 (2.6)	1.4 (0.19-10)	0.76
Chronic liver disease	3 (3.2)/2 (5.1)	1.4 (0.34-5.9)	0.62
Hemodialysis	2 (2.2)/5 (13)	4.0 (1.5-10)	< 0.01

¹Non-selective NSAIDs included loxoprofen, diclofenac, naproxen, etodolac, zaltoprofen, meloxicam, lornoxicam, and celecoxib (n = 3). Distribution type was defined as follows: right-sided, involving the transverse or proximal colon; left-sided, involving the descending or distal colon; or bilateral, involving the entire colon. Low-dose aspirin included enteric-coated aspirin (100 mg) and buffered aspirin (81 mg). Non-aspirin antiplatelets included ticlopidine, clopidogrel, cilostazol, dipyridamole, sarpogrelate hydrochloride, ethyl icosapentate, dilazep, limaprost, and beraprost. Anticoagulants included warfarin and dabigatran etexilate. CI: Confidence interval; NSAIDs: Non-steroidal anti-inflammatory drugs.

Table 3 Risk factors for rebleeding after discharge on multivariate analysis (n = 132)

Factor	Hazard ratio (95%CI)	P
Age > 70 yr	1.2 (0.6-2.3)	0.68
Right-sided diverticula	0.6 (0.3-1.5)	0.29
Continued NSAID use	4.6 (2.2-9.4)	< 0.01
Hypertension	1.3 (0.6-2.8)	0.43
Hemodialysis	3.0 (1.1-7.8)	0.03

CI: Confidence interval; NSAIDs: Non-steroidal anti-inflammatory drugs.