NSAIDS and Gastrointestinal Complications
RR <2: aceclofenac, celecoxib and ibuprofens
RR 2-4: rofecoxib , sulindac, diclofenac , meloxicam, nimesulide and ketoprofen
RR 4-5: tenoxicam , naproxen , indomethacin and diflunisal
RR >5: piroxicam, ketorolac and azapropazone
In summary, there are no clear guidelines about the use of NSAIDS and screening for gastrointestinal complications. It is recommended that patients at risk of GI complications either receive a non-selective NSAID with a gastroprotective agent or a selective cox-2 inhibitor. Clinicians should use the “safest” NSAIDS, at the lowest dose, for the shortest period of time. They should avoid NSAIDS with higher gastrointestinal risk. Patients on anticoagulation, oral corticosteroids, low dose ASA or antiplatelet medications should not take NSAIDS. Note that when combined with low-dose aspirin, the benefit of the low risk NSAIDS and coxibs tend to disappear .