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Subject “Concomitant NSAID Treatment Increases the Risk for Cardiovascular Events by Seven and the Risk for Brain Hemorrhage by Four”
Selection News Date 2020-07-28 Read 60

“Concomitant NSAID Treatment Increases the Risk

 

for Cardiovascular Events by Seven and the Risk for

 

Brain Hemorrhage by Four”

 

 

A research team of Guro Hospital Cardiovascular Center conducted a cohort

 

study of 110,000 patients with acute myocardial infarction

 

 

Largest in the world, suggesting treatment strategies applicable to the wider

 

population groups

 

 

Concomitant nonsteroidal anti-inflammatory drug (NSAID) and antiplatelet

 

treatment increase the risk for cardiovascular events such as myocardial

 

infarction (MI) and stroke by seven and the risk for bleeding events by 4

 

compared with no NSAID treatment after MIaccording to a study.

 

 

A research team led by Professor Chul-Ung Choi of Korea University Guro

 

Hospital Cardiovascular Center (Professor Chul-Ung Choi and Professor Dong

 

Oh Kang of Korea University Guro Hospital Cardiovascular Center, Professor

 

Hyonggin An of Department of Biostatistics of Korea University, Geun U Park

 

of Linewalks) conducted a cohort study of 110,000 domestic patients first

 

diagnosed with acute MI from 2009 to 2013 using the Health Insurance Review

 

and Assessment Service database. The mean follow-up duration was 2.3 years,

 

and the analysis of the association between NSAID and cardiovascular events

 

(MI, stroke, systemic embolism) and bleeding events (gastrointestinal, brain,

 

respiratory, or urinary tract bleeding) showed that concomitant NSAID and

 

antiplatelet treatment increase the risk for cardiovascular events by seven and

 

the risk for bleeding events by four.

 

 

Among the NSAID subtypes, celecoxib and meloxicam, selective COX-2

 

inhibitors, showed a relatively low risk for bleeding events and cardiovascular

 

events.Both cardiovascular and bleeding risks were relatively lowered by

 

celecoxib compared with other NSAIDs; the relative cardiovascular and

 

bleeding risks were reduced by 35% to 40% and by 15% to 20% compared with

 

other NSAIDs, respectively.

 

 

Patients with acute MI need to maintain antiplatelets for life. As population

 

aging advances recently, the prevalence of atherosclerosis and acute MI and the

 

prescription for NSAIDs due to musculoskeletal disease are on the rise.

 

Consequently, the number of patients who are frequently exposed to NSAIDs

 

because of secondary prevention of cardiovascular disease and symptom

 

management of musculoskeletal disease is increasing.

 

 

Concomitant administration of antiplatelets and NSAIDs have been reported to

 

increase the risk of adverse cardiovascular events and bleeding events.

 

Therefore, recent guidelines have discouraged the use of NSAIDs in patients

 

with established cardiovascular disease. However, limited data are available as

 

the evidence on NSAID treatment after MI was based mostly on study results

 

from the Western population. Also, some patients with acute MI need to take

 

NSAIDS for symptom management of their musculoskeletal disease or

 

inflammatory disease. Investigation of the risk for cardiovascular and bleeding

 

events according to groups of antithrombotic medications and subtypes of

 

NSAIDs in patients with MI was needed.

 

 

“In patients with acute MI, the prescription of NSAIDs should be avoided as

 

much as possible, but this study presents the accurate risk of cardiovascular and

 

bleeding events for NSAIDs and a new evidence that selective COX-2 inhibitors

 

can be considered an alternative option in case NSAID use is unavoidable,”

 

Professor Kang, first author of the study, said.

 

 

“We investigated the risk for cardiovascular events associated with concomitant

 

NSAID treatment from the largest contemporary cohort of patients with MI,”

 

Professor Choi, a corresponding author, said. “Our study adds important value

 

to the currently available evidence for concomitant NSAID treatment after MI

 

by constituting global evidence that encompasses diverse population groups.”

 

 

The study “Cardiovascular and Bleeding Risks Associated with Nonsteroidal

 

Anti-Inflammatory Drugs After Myocardial Infarction” was published in the

 

August issue of Journal of the American College of Cardiology (JACC)

 

[2019 JCR Impact Factor 20.589], a world-renown journal published by

 

American College of Cardiology (ACC).

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