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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Stroke risk increased by NSAIDs

The Archives on Internal Medicine has published the results of a prospective observational study that examined the association between non-steroidal anti-inflammatory drug (NSAID) use and risk of stroke.

The study collected data on 7,636 participants who had never had a stroke, the average age was 70 years old and over half were female. 807 people developed a stroke (460 ischaemic, 74 haemorrhagic, and 273 unspecified).

The hazard ratio for users of non-selective NSAIDs was 1.72 (95% CI 1.22 - 2.44) and for users of COX-II selective NSAIDs it was 2.75 (95% CI 1.28 - 5.95). The authors conclude that there is a ,"greater risk of stroke with current use of non-selective and COX-2–selective NSAIDs".

Advice issued by the Medicines and Healthcare products Regulatory Agency in 2006 warned that NSAIDs carry a thrombotic risk that had the potential to increase heart attacks and strokes. This study is further confirmation that there is an increased risk of stroke.

Action: Clinicians should be aware of all of the risks associated with NSAIDs use. Assessment of overall cardiovascular risk, including strokes, should be undertaken before starting treatment and during medication reviews.

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