Patients selected for the study had arthritis and cardiothrombotic diseases and had a resolved case of upper gastrointestinal bleeding (healed ulcer), but required ongoing NSAIDs (for arthritis) and aspirin. Esomeprazole was administered concomitantly.
A related commentary highlights that the superiority of celecoxib was relative, and that neither option was safe given the cumulative rates of bleeding. For a patient to choose to continue a NSAID along with aspirin after having upper gastrointestinal bleeding is thus a hugely consequential decision. The trial’s lost opportunity to fully inform guidelines is its failure to include a non-NSAID treatment group composed of patients needing aspirin whose pain was adequately managed with simple analgesia. The substantial proportion of patients with rebleeding reported in the study should reinforce NSAID avoidance in people with previous upper gastrointestinal bleeding.