In a new study, researchers found the use of NSAIDs to treat first-time heart attack patients strongly increased the risk of heart disease and bleeding risks.
The research was conducted by a team at the Korea University College of Medicine.
Current guidelines discourage the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with established heart disease.
While established in Western populations, there has been no available data to report the level of cardiovascular and bleeding risk with NSAIDs treatment.
This is the first population-based study to test the cardiovascular and bleeding risk linked to NSAIDs treatment in a non-Western population with heart attacks.
In the study, the team enrolled 108,232 patients admitted for a first-time heart attack between 2009 and 2013, with a follow-up period of 2.3 years.
The researchers tracked prescriptions for antithrombotic medications (including aspirin, clopidogrel and oral vitamin K antagonist) and NSAIDs (including naproxen, ibuprofen, diclofenac, celecoxib, meloxicam and more).
Among antithrombotic medications, dual antiplatelet therapy (DAPT) with aspirin and clopidogrel was the most frequently prescribed at 87.9%.
Diclofenac was the most frequently prescribed NSAID in patients with either cardiovascular or bleeding event outcomes, 71.8% and 68.9%, respectively.
The team found cardiovascular and bleeding risk increased within seven days after patients began NSAIDs treatment.
A primary cardiovascular event (including heart attack, stroke or blood clotting) developed in 26.2% of patients prescribed NSAIDs.
Among the NSAIDs subtypes, celecoxib and meloxicam showed the lowest risk of cardiovascular events, with similar trends in the DAPT subgroup.
Secondary bleeding events developed in 23.4% of patients. Like cardiovascular events, celecoxib, meloxicam and DAPT showed the lowest risk of bleeding events.
According to the researchers, NSAIDs treatment should be limited as much as possible after a heart attack, however, the data suggest that celecoxib and meloxicam could be considered as a possible alternative choice in patients where NSAIDs prescription is inevitable.
The study demonstrated that cardiovascular risk increased strongly when patients were prescribed NSAIDs subtypes naproxen or ibuprofen.
One author of the study is Cheol Ung Choi, MD, Ph.D., a professor in the cardiovascular center.
The study is published in the Journal of the American College of Cardiology.
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