Corticosteroid-Associated Gastrointestinal Bleeding Risk

Patient Risk Factors

A history of peptic ulcer disease or prior gastrointestinal bleeding is the strongest predictor of recurrent bleeding, according to the American Heart Association, as published in Circulation 1
Age ≥75 years increases the risk approximately 4% per year, as recommended by the European Society of Cardiology 2
Concurrent use of NSAIDs increases the risk approximately 2-fold, as stated by the American College of Cardiology 1
Concurrent use of anticoagulants increases the risk approximately 3-fold, as reported by the European Heart Journal 1
Concurrent use of antiplatelet agents significantly increases bleeding risk, according to the European Society of Cardiology 3
High alcohol consumption increases the risk of gastrointestinal bleeding, as noted by the European Heart Journal 4
Helicobacter pylori infection increases the risk of gastrointestinal bleeding, as stated by the American Heart Association, as published in Circulation 1

For patients at increased risk of gastrointestinal bleeding who require corticosteroids, gastric protection with a proton pump inhibitor (PPI) is recommended for the duration of therapy, as advised by the European Society of Cardiology 4
PPIs reduce the risk of upper gastrointestinal bleeding by approximately 75-85% in high-risk patients, as recommended by the European Society of Cardiology 2
PPIs provide superior protection compared to H2-receptor antagonists, according to the European Society of Cardiology 2