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GPs urged to consider myocardial infarction risk when prescribing NSAIDs

Researchers are calling for prescribers to weigh up the risks and benefits of initiating high-dose NSAID treatment, after an analysis found that patients taking the drugs for just a week had an increased risk of myocardial infarction.

The meta-analysis, lead by researchers in Canada, Germany and Finland and published in the BMJ, found that patients’ risk of having a myocardial infarction increased significantly after taking a common NSAID for just a week, with the risk increasing for higher doses.

Looking at data for 446,763 patients, 61,460 of whom suffered a myocardial infarction, the analysis found that the probability of the drugs increasing the patients’ risk of myocardial infarction was 97% for ibuprofen and 99% for diclofenac, naproxen, and rofecoxib after one week of use, with the risk being greatest in the first month. The risk also increased with increased dosage.

The overall likelihood of having a myocardial infarction was about 20-50% greater with NSAID use, compared to not taking the drugs at all.

The researchers said: ‘Given that the onset of risk of acute myocardial infarction occurred in the first week and appeared greatest in the first month of treatment with higher doses, prescribers should consider weighing the risks and benefits of NSAIDs before instituting treatment, particularly for higher doses.’

Although other studies have highlighted the potential assosciation between NSAID use and cardiac events, this analysis is the largest of its kind and helps to clarify how the dose and type of NSAID affects the risk of having a myocardial infarction, they said.

RCGP chair Professor Helen Stokes-Lampard said: ‘The use of NSAIDs in general practice to treat patients with chronic pain is reducing and some of the drugs in this study are no longer routinely prescribed in the UK, such as coxibs, as we know that long term use can lead to serious side effects for some patients.

'But these drugs can be effective in providing short term pain relief for some patients – what is important is that any decision to prescribe is based on a patient’s individual circumstances and medical history, and is regularly reviewed.’

This analysis comes as earlier this year researchers called for the sale of ibuprofen to be limited to pharmacies over concern that the drug increased the risk of cardiac arrest by 31%

BMJ 2017; accessed 10 May

Readers' comments (3)

  • Did we not all know this????

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  • Dear All,
    Yes we did, we all know that Diclofenac increases the risk by 42% to a whopping absolute risk of 1.42% which is why professionals still use it, as should any sensible physician.
    Paul C

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  • Rogue1

    If the increased risk is 99% more heart attacks after one week but then overall 20-50%, does that mean the risk is on initiation. So with longer use the risk comes down? If a patient needs nsaid for pain relief, and haven't had an MI in the first week then its probably ok to continue.
    It does help inform them, but at the end of the day its the patients choice!

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