The Lancet has published a review article that aims to assess whether patients who are at risk of cardiovascular events and are taking low dose aspirin as prophylaxis would be better taking a standard non-steroidal anti-inflammatory (NSAID) or a COX-II selective non-steroidal anti-inflammatory (Coxib).
The summary of the article admits that arriving at conclusions in this area is difficult because:
- Trials have not answered directly whether low-dose aspirin is cardioprotective when combined with coxibs
- Comparing cardiovascular and gastrointestinal risks is difficult
- The likelihood and severity of cardiovascular events differ between individuals
- The cardiovascular risk posed by all NSAIDs varies by agent and exposure
- Mortality associated with gastrointestinal events is less frequent
Despite all of this the article concludes that, "data support the conclusion that COX-2 inhibitors are preferable to non-selective NSAIDs in patients with chronic pain and cardiovascular risk needing low-dose aspirin". However, it is also stated that risks and benefits need to be assessed individually.
The article does not appear to assess the place of using a standard NSAID with a gastroprotective agent such as a proton pump inhibitor unlike the recent MeReC Extra that covered the same topic.
Action: This recent article adds nothing new to the NSAID debate. Clinicians would be better served reading the MeReC Extra when looking for a balanced assessment of the risks and benefits of NSAID and coxibs.