Which of these drug classes can contribute to gastrointestinal bleeding if taken long-term without protective measures?

Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) is well-documented to contribute to gastrointestinal bleeding due to their mechanism of action. NSAIDs work by inhibiting cyclooxygenase (COX) enzymes, which are important for the production of prostaglandins. Prostaglandins play a key role in maintaining the gastric mucosal lining, promoting mucus and bicarbonate secretion, and maintaining blood flow to the stomach lining. When these drugs inhibit prostaglandin synthesis, the protective mechanisms of the gastric mucosa are compromised, resulting in potential gastric irritation, ulceration, and bleeding.

Although analgesics, anticoagulants, and aspirin can also affect the gastrointestinal tract, the specific association of NSAIDs with serious gastrointestinal complications is particularly strong. Aspirin, while related to the NSAID class, is often considered separately, as it has unique properties and gastrointestinal risks. However, it is important to note that when aspirin is used in a long-term setting, it can also cause bleeding; therefore, careful consideration and protective measures (like gastroprotective agents) are recommended for patients in need of long-term treatment with NSAIDs.