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MAUI, HAWAII – An as-yet unpublished white paper on the appropriate use of nonsteroidal anti-inflammatory drugs contains mostly common sense advice, save for a small controversy over whether to use naproxen in patients taking low-dose aspirin for cardioprotection.
The white paper, from the American College of Rheumatology, sanctions acetaminophen or naproxen in such patients, said co-author Dr. John Cush, director of clinical rheumatology, Baylor Research Institute, and professor of medicine and rheumatology, Baylor University Medical Center, Dallas, at a symposium sponsored by Excellence in Rheumatology Education. But Dr. Vibeke Strand of Stanford (Calif.) University, an audience member, said there is no statistically significant evidence to support its use.
Dr. Cush said: “If aspirin is required for any patient for cardioprotection, you should seriously consider avoiding nonsteroidals of all kinds, including [cyclooxygenase-2s].”
When aspirin is needed, a gastroprotective drug like misoprostol or a proton pump inhibitor like esomeprazole should be used. For patients at GI risk, a selective cyclooxygenase-2 inhibitor is best, he said. But, “if you're going to use a nonselective nonsteroidal, you should use a PPI or misoprostol with it.”
Dr. Cush said that the white paper is based on existing osteoarthritis guidelines from the ACR, OA guidelines from EULAR (the European League Against Rheumatism), and reviews by the Cochrane Collaboration.
Other tenets of the white paper hold that patients on long-term NSAIDs require close monitoring of the complete blood count, liver function, and blood pressure. Physicians should avoid nonselective NSAIDs and cyclooxygenase-2 inhibitors in patients with renal or liver disease. and avoid nonselective NSAID use in patients on anticoagulants or who have chronic thrombocytopenia.
Dr. Cush has financial ties to: Abbot, Biogen/Idec, Genentech, Pfizer, Targeted Genetics, UCB, Wyeth, Centocor, and Novartis.
If a patient takes aspirin for heart protection, 'you should seriously consider avoiding nonsteroidals of all kinds.' DR. CUSH
MAUI, HAWAII – An as-yet unpublished white paper on the appropriate use of nonsteroidal anti-inflammatory drugs contains mostly common sense advice, save for a small controversy over whether to use naproxen in patients taking low-dose aspirin for cardioprotection.
The white paper, from the American College of Rheumatology, sanctions acetaminophen or naproxen in such patients, said co-author Dr. John Cush, director of clinical rheumatology, Baylor Research Institute, and professor of medicine and rheumatology, Baylor University Medical Center, Dallas, at a symposium sponsored by Excellence in Rheumatology Education. But Dr. Vibeke Strand of Stanford (Calif.) University, an audience member, said there is no statistically significant evidence to support its use.
Dr. Cush said: “If aspirin is required for any patient for cardioprotection, you should seriously consider avoiding nonsteroidals of all kinds, including [cyclooxygenase-2s].”
When aspirin is needed, a gastroprotective drug like misoprostol or a proton pump inhibitor like esomeprazole should be used. For patients at GI risk, a selective cyclooxygenase-2 inhibitor is best, he said. But, “if you're going to use a nonselective nonsteroidal, you should use a PPI or misoprostol with it.”
Dr. Cush said that the white paper is based on existing osteoarthritis guidelines from the ACR, OA guidelines from EULAR (the European League Against Rheumatism), and reviews by the Cochrane Collaboration.
Other tenets of the white paper hold that patients on long-term NSAIDs require close monitoring of the complete blood count, liver function, and blood pressure. Physicians should avoid nonselective NSAIDs and cyclooxygenase-2 inhibitors in patients with renal or liver disease. and avoid nonselective NSAID use in patients on anticoagulants or who have chronic thrombocytopenia.
Dr. Cush has financial ties to: Abbot, Biogen/Idec, Genentech, Pfizer, Targeted Genetics, UCB, Wyeth, Centocor, and Novartis.
If a patient takes aspirin for heart protection, 'you should seriously consider avoiding nonsteroidals of all kinds.' DR. CUSH
MAUI, HAWAII – An as-yet unpublished white paper on the appropriate use of nonsteroidal anti-inflammatory drugs contains mostly common sense advice, save for a small controversy over whether to use naproxen in patients taking low-dose aspirin for cardioprotection.
The white paper, from the American College of Rheumatology, sanctions acetaminophen or naproxen in such patients, said co-author Dr. John Cush, director of clinical rheumatology, Baylor Research Institute, and professor of medicine and rheumatology, Baylor University Medical Center, Dallas, at a symposium sponsored by Excellence in Rheumatology Education. But Dr. Vibeke Strand of Stanford (Calif.) University, an audience member, said there is no statistically significant evidence to support its use.
Dr. Cush said: “If aspirin is required for any patient for cardioprotection, you should seriously consider avoiding nonsteroidals of all kinds, including [cyclooxygenase-2s].”
When aspirin is needed, a gastroprotective drug like misoprostol or a proton pump inhibitor like esomeprazole should be used. For patients at GI risk, a selective cyclooxygenase-2 inhibitor is best, he said. But, “if you're going to use a nonselective nonsteroidal, you should use a PPI or misoprostol with it.”
Dr. Cush said that the white paper is based on existing osteoarthritis guidelines from the ACR, OA guidelines from EULAR (the European League Against Rheumatism), and reviews by the Cochrane Collaboration.
Other tenets of the white paper hold that patients on long-term NSAIDs require close monitoring of the complete blood count, liver function, and blood pressure. Physicians should avoid nonselective NSAIDs and cyclooxygenase-2 inhibitors in patients with renal or liver disease. and avoid nonselective NSAID use in patients on anticoagulants or who have chronic thrombocytopenia.
Dr. Cush has financial ties to: Abbot, Biogen/Idec, Genentech, Pfizer, Targeted Genetics, UCB, Wyeth, Centocor, and Novartis.
If a patient takes aspirin for heart protection, 'you should seriously consider avoiding nonsteroidals of all kinds.' DR. CUSH