Warning over post-MI NSAID use
medwireNews: Researchers caution against prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) to patients who have suffered a heart attack, because of a persistently increased risk of further coronary events associated with their use.
"It would seem prudent to limit NSAID use among patients with cardiovascular disease and to get the message out to clinicians taking care of these patients that NSAIDs are potentially harmful, even 5 years after MI [myocardial infarction]," write Dr Anne-Marie Schjerning Olsen (Copenhagen University Hospital Gentofte, Hellerup, Denmark) and colleagues in Circulation.
The study included 99,187 patients admitted to hospital with a first MI in Denmark, who were still alive 30 days after discharge, during a 13-year period. Overall, 43,608 (44%) filled at least one prescription for an NSAID. During the study period, ibuprofen was the only NSAID available over-the-counter in Denmark.
The current use of any NSAID was associated with increased mortality throughout follow-up over 5 years. For example, at 1 year the risk of death was 59% higher among users than nonusers; at 2 years the risk was increased 84% and after 5 years it remained 63% higher in users of NSAIDs.
The relative risk of coronary death or non-fatal MI was also 30 to 65% greater among NSAID users throughout follow-up.
The authors note that diclofenac was associated with the greatest increases in risk and, in agreement with previous findings, that naproxen appeared to carry the least cardiovascular risk.
The MHRA cautions that all patients treated with NSAIDs are at increased thrombotic risk, including those without baseline risks, and advises the drugs only be prescribed at the lowest possible doses, for the shortest periods of time.
However, Schjerning Olsen and team say that a greater focus is needed on NSAIDs after MI, the high usage of which they describe as "worrying". They suggest that this could even include reconsideration of the over-the-counter availability of NSAIDs.
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By Kirsty Oswald