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A9.14 An observational study of the prevalence and clinical impact of NSAIDS on anemia and hemoglobin drop on clinical settings
  1. Augusto Faustino
  1. Rheumatologic Clinic of Lisbon (RCL)

Abstract

Background and Objectives Define the prevalence and clinical impact of the finding of anemia and decreased hemoglobin in a population of patients with osteoarthritis (OA) from the RCL, treated with NSAIDs permanently. Additionally, evaluate differences of the effect of anti-inflammatory medication in Hb and haematocrit (Htc), comparing Coxibs with nsNSAIDs.

Material and Methods Observational study of all the consulted patients of the RCL since its beginning in 2000, with clinical diagnose of OA, taking NSAIDs permanently for at least six months, and with at least two registries of hematologic parameters in clinical files (an initial value prior to beginning of NSAID and a final value, after a minimal six months exposure).

Results 289 case studies; mainly females (90%), with a regular distribution between class ages.

NSAID therapy – 52.2% of patients used a Coxib (mainly Celecoxib); the remaining patients took 11 different nsNSAID. Therapy was continuous in 83.3% of the patients.

We note 69 Adverse Events (AE), mainly dyspepsia. Only 6 patients (2% of total, and 8.7% of patients with AE) stopped NSAIDs as a result of these AE (1 Coxib and 5 nsNSAIDs).

Hemoglobin changes

We report an Hb decrease in 133 cases (46% of total); only one patient reach the anemia level with a decrease in Hb superior to 2 gr/dl.

28 of this patients (9.7% of total) reach anemia levels on final evaluation, with a statistically significant difference between patients taking nsNSAID than Coxibs globally (p = 0.028) or Celecoxib (p = 0.015).

13 patients (4.5% of total), present anemia on final evaluation without anemia on initial evaluation. In this subset of patients there was statistically significant less patients presenting anemia on final evaluation (without anemia on initial evaluation) taking Coxibs, globally (p = 0.044) or Celecoxib (p = 0.021).

Conclusion We conclude that the use of NSAIDs in this specific clinical context was very safe, with a low number of AE (none serious AE), but with a difference in survival on treatment between nsNSAIDs and Coxib patients.

Results shows that it was possible to detect clinically relevant Hb drops in a real life clinic population, and that utilization of Coxibs, may assure a safer continuous use and reduce the risk of appearance of anemia or Hb drops with this chronic use.

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