By Alisdair Stirling
Short courses of NSAIDs are associated with a 45% higher risk of death or heart attack in patients with a history of a previous myocardial infarction, researchers say.
The study was not able to show if the association was causative, but the BNF does warn caution is required in patients with cardiac impairment.
A study of 83,675 patients aged 30 and over in the Danish National Patient Registry with prior MI showed they were at increased risk of death or recurrent myocardial infarction if they took NSAIDs even for periods as short as one week.
Researchers from Copenhagen University identified prescriptions for NSAIDs after discharge for 42.3% of the patients – a total of 35,405. Some 35,257 deaths or recurrent myocardial infarctions were registered in the database.
The study showed the use of NSAIDs was associated with a 45% higher risk for death or recurrent MI in the first seven days of treatment compared to controls.
The risk persisted throughout the treatment course, rising to 55% after 90 days. All NSAIDs were associated with an increased risk for death or recurrent myocardial infarction, but diclofenac was associated with the highest increase in risk, with more than a three-fold increased risk during the first week of treatment.
Lead researcher Dr Anne-Marie Schjerning Olsen, a research fellow in the department of cardiology at the Copenhagen University Hospital said: ‘The present results indicate that there is no apparent safe therapeutic window for NSAIDs in patients with prior myocardial infarction and challenge the current recommendations of low-dose and short-term use of NSAIDs as being safe.’
‘Neither short nor long-term treatment with NSAIDs is advised in this population, and any NSAID use should be limited from a cardiovascular safety point of view.’
Circulation 2011, published online 9 May
Even short-course NSAIDs raise MI risk