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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NSAIDs and Myocardial Infarction

Bandolier has reviewed an observational study examining the association between NSAIDs and myocardial infarction that was originally published in the Archives of Internal Medicine.

The study collected data on 10,280 myocardial infarctions and compared these patients with ten controls matched for age and sex. Prescription data were collected for NSAIDs, Coxibs and high-dose aspirin.

Prescriptions were categorised as follows:

  • New - first prescription filled within 30 days
  • Current - prescription filled within 30 days
  • Recent - prescription filled within 30-90 days
  • Past - prescription not filled within 90 days

Coxib and NSAID use was higher in all categories of patient when comparing cases to controls. The adjusted relative risk was higher and statistically significant for all drugs other than naproxen and celecoxib, although this may be due to the small number of cases identified (26 and 71 respectively).

Confounders in the study include failure to collect data on lifestyle, diet or the dosage of the NSAID or coxib. Despite these flaws the study raises questions about the cardiovascular safety of all NSAIDs (selective and non-selective).

Action: Clinicians should always consider the risks of NSAIDs before prescribing and during medication reviews. The risk consideration should include assessment of cardiovascular, renal and gastrointestinal risks.

If NSAID therapy is necessary follow the MHRA advice and:

  • use the lowest risk NSAID
  • at the lowest dose
  • for the shortest possible duration

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