The risk of significant injury to the gastrointestinal (GI) tract from nonsteroidal anti-inflammatory drugs (NSAIDs) has been well established. Patients concurrently using warfarin or who have had a prior serious hospital GI event are considered to be at high risk. In 2000, the Veterans Affairs (VA) implemented treatment criteria for the use of NSAIDs including cyclooxygenase -2 (COX-2) inhibitors. The high-risk criteria-based therapy is salsalate, non-selective NSAID plus a proton pump inhibitor (PPI), high-dose famotidine, or misoprostol or a COX-2 inhibitor. OBJECTIVES: The purpose of this study was to assess the level of criteria-based NSAID prescribing in high risk patients at the New Mexico VA Healthcare System. METHODS: Patients with concurrent prescriptions for an NSAID and warfarin or previous hospital GI event were identified utilizing VA databases. Current therapy was compared to criteria-based therapy to assess level of implementation. RESULTS: Out of 7,625 NSAID users, 184 patients were identified: concurrent warfarin (n=98), prior hospital GI event (n=84), and concurrent warfarin with a previous hospital GI event (n=2). Fifty-eight percent were over the age of sixty-five. The NSAIDs prescribed were ibuprofen (42.4%), naproxen (20.1%), etodolac (16.8%), indomethacin (8.2%), salsalate (5.4%), piroxicam (3.3%), COX-2 inhibitors (2.1%), and sulindac (1.6%). Criteria-based therapy was prescribed for 22% of patients. Only 12% of warfarin patients and 33% of previous hospital GI event patients were prescribed criteria-based therapy. Of the patients prescribed a non-selective NSAID (n=139), there were only 19% prescribed a criteria-based GI protective medication. CONCLUSIONS: In this study, few patients, at high-risk for GI complications due to NSAIDs, received criteria-based therapy.