Pattern, indications and gastrointestinal complications of over-the-counter traditional non-steroidal anti-inflammatory drug use among haemophiliacs in northern Nigeria: a critical appraisal of a small case series

Abstract

Background: coagulation factor VIII (FVIII) is scarce in Nigeria. Therefore, musculo-skeletal bleeding and other painful conditions including dental diseases are neither promptly nor optimally treated, thus encouraging self-medication with traditional non-steroidal anti-inflammatory drugs (tNSAIDs), which are associated with gastrointestinal bleed. Frequency of self-medication with tNSAIDs among Nigerian haemophiliacs is unknown. Hence, pattern of tNSAID-associated gastrointestinal complications has not been documented.

Objective: To determine pattern, indications and gastrointestinal complications of over-the-counter tNSAIDs self-medications among Nigerian haemophiliacs.

Methodology: Retrospective analysis of demographic and clinical data of 17 haemophiliacs who used tNSAIDs on self-medication and subsequently self-reported at hospitals because of intolerable gastrointestinal symptoms as documented in five tertiary hospitals.

Result: Indications for tNSAIDs self-medication showed adults had higher prevalence of chronic arthropathy (42.9%vs.10%), while children had higher prevalence of acute haemarthrosis (30%vs.14.3%) and toothache (30%vs.14.3%). Mean number of days of tNSAIDs consumption was 3.8 (for patients who reported dyspepsia only), 6.9 (for patients who reported dyspepsia and melaena), and 9.4 (for patients who reported dyspepsia, melaena and haematemesis).

Conclusion: tNSAIDs are not safe in haemophiliacs. Risk and severity of tNSAID-induced dyspepsia and gastrointestinal bleed in haemophiliacs correlated with duration of consumption. Government should set-up haemophilia centres with adequate FVIII for optimal and prompt management of musculo-skeletal, dental and other morbidities. Healthcare personnel should intensify counseling against tNSAIDs self-medication, and ensure pain is always promptly and optimally managed according to World Federation of Haemophilia guidelines for safe analgesia in haemophilia.

Keywords: Haemophilia-A, Musculo-skeletal pain, Toothache, Analgesics, Melaena, Haematemesis