Some common anti-inflammatory drugs may raise risks of bleeding, heart disease

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Current guidelines discourage the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with established heart disease.

While established in Western countries, there has been no available data to report the level of cardiovascular and bleeding risk with NSAIDs treatment.

In a recent study at the Korea University, researchers found the use of NSAIDs to treat first-time heart attack patients strongly increased the risk of heart disease and bleeding risks.

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.

The study is published in the Journal of the American College of Cardiology. One author is Cheol Ung Choi, MD, Ph.D.

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.

They 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 heart disease 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 shows that heart risk increased strongly when patients were prescribed NSAIDs subtypes naproxen or ibuprofen.

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