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A large, retrospective study has shown that nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the risk of bleeding and cardiovascular events in patients who are receiving antithrombotic therapy after myocardial infarction (MI).
The risks were increased regardless of the type of antithrombotic treatment patients received, the types of NSAIDs they were prescribed, or the duration of NSAID use.
Researchers reported these findings in JAMA.
Anne-Marie Schjerning Olsen, MD, PhD, of Copenhagen University Hospital Gentofte in Hellerup, Denmark, and her colleagues conducted the research. They used nationwide administrative registries in Denmark (2002-2011) to analyze patients 30 years of age or older who were admitted with first-time MI and were alive 30 days after hospital discharge.
The team looked at subsequent treatment with aspirin, clopidogrel, or other oral anticoagulants and their combinations, as well as ongoing, concomitant, prescription NSAID use. They assessed the risk of bleeding requiring hospitalization and a composite cardiovascular outcome (cardiovascular death, nonfatal recurrent MI, and stroke).
The study included 61,971 patients with a mean age of 68 years. Thirty-four percent of these patients filled at least 1 NSAID prescription.
At a median follow-up of 3.5 years, 18,105 patients (29.2%) had died. There were 5288 bleeding events (8.5%) and 18,568 cardiovascular events (30.0%).
A multivariate analysis showed that NSAID use increased the risk of bleeding (hazard ratio, 2.02) and cardiovascular events (hazard ratio, 1.40). The increased risk of these events was present regardless of the type of antithrombotic treatment, the types of NSAIDs used, or the duration of NSAID use.
Dr Schjerning Olsen and her colleagues said additional research is needed to confirm these findings, but physicians should exercise caution when prescribing NSAIDs to patients with a recent MI.
Authors of a related editorial pointed out that this study only included prescription NSAID use. In countries where NSAIDs are available over the counter, physicians may be unaware that patients are taking these drugs.
