Prevention

If patients need to continue NSAIDs, consider ibuprofen ^b at the lowest possible dose ^b

Why?

• It is least likely of the NSAIDs to cause serious gastrointestinal complications ^b
• Using safer NSAIDs is more effective than adding in misoprostol. ^a
• The risk of GI complications increases with higher daily doses ^b

Ibuprofen is the safest NSAID

Outcome	Risk Factor	PEER	OR (95% CI)	NNH (95% CI)
bleeding peptic ulcer b	ibuprofen independent	0.05%	2.0 (1.4 to 2.8)	2000 (1100 to 5000)

Swapping to nambumetone is safer than adding misoprostol to naproxen.

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
recent upper GI bleed due to ulcers and on long-term NSAIDs a	nambumetone	naproxen and misoprostol	recurrent upper GI bleeding at 6 months	21%	70% (-2% to 91%)	7 (4 to 83)