Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Do all NSAIDs increase post-MI mortality?

An epidemiological study conducted on Danish patients reported by the American Heart Association has concluded that taking NSAIDs (including COX-II selective NSAIDs) after a heart attack increases the risk of death.

The Hazard ratios for certain NSAIDs are as follows:

  • 4.24 for Celecoxib at 200mg/day or more
  • 1.70 for Celecoxib at lower doses
  • 5.03 for Rofecoxib at 25mg/day or more
  • 2.23 for Rofecoxib at lower doses
  • 3.76 for Diclofenac at 100mg/day or more
  • 1.96 for Ibuprofen at 1200mg/day or more
  • 1.22 for other NSAIDs

The hazard ratios were lower with low doses of Ibuprofen (0.66) and Diclofenac (0.74). There were confounders in this study and an extension to the study will follow up the actual cause of death. Also, there was no association with recurrent MI. The full study has not yet been published and will need further investigation.

The lead author, Gunnar H. Gislason, said, "These results are a cause for concern but not panic. If you can avoid them, it makes sense to switch to another type of medication if you have cardiovascular disease."

Action: This study does not add to what we already know but it does raise awareness again. NSAIDs should be avoided where possible, and when they are required the NSAID with the lowest risk (usually Ibuprofen) should be used at the lowest dose for the shortest duration.

NOTE: This study did not include Aspirin.

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