ANTI-INFLAMMATORY DRUGS AND ANTITHROMBOTIC THERAPY
Schjerning Olsen AM, Gislason GH, McGettigan P, et al. Association of NSAID use with risk of bleeding and cardiovascular events in patients receiving antithrombotic therapy after myocardial infarction. JAMA. 2015;313(8):805-814.
Combining prescription NSAIDs with antithrombotic therapy following myocardial infarction (MI) increases the risk for bleeding and excess thrombotic events, according to a study of 61,971 MI patients with ongoing antithrombotic therapy.
During an average of 3.5 years’ follow-up, patients who had taken NSAIDs had increased rates of bleeding and cardiovascular events, with incidence rates per 100-person years as follows:
The study authors note that clinicians should use caution when prescribing NSAIDs to patients who have recently experienced MI.
COMMENTARY
The use of NSAIDs in patients who have had coronary disease has been an area of concern for almost a decade. In 2007, the American Heart Association issued a scientific advisory update discouraging use of COX-2 inhibitors in patients with coronary disease and concluding that more data are needed on the cardiovascular safety of conventional NSAIDs.1 Non-COX-2 selective NSAIDs, such as naproxen, appear to have a better cardiovascular safety profile than those with more COX-2 inhibition. They do carry an increased risk for bleeding. The study reviewed above suggests that patients who have been given NSAIDs, even for a short amount of time, have an increased risk for both bleeding and cardiovascular events, reminding us to carefully weigh the risk and benefit of using these commonly prescribed medications. —NS
REFERENCE
1. Antman EM, Bennett JS, Daugherty A, Furberg C, Roberts H, Taubert KA; American Heart Association. Use of nonsteroidal anti-inflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association. Circulation. 2007;115(12):1634-1642.
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