Bleeding rates higher when pairing MI treatment with NSAIDs

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Findings published Feb. 24 in JAMA suggest caution may be required when prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) for patients with a recent MI. The population study noted that MI patients taking one or more NSAIDs had increased risk for bleeding compared with patients who weren’t taking them.

Taking data from Danish databases, Anne-Marie Schjerning Olsen, MD, PhD, of the Copenhagen University Hospital Gentofte in Hellerup, Denmark, and colleagues analyzed bleeding and cardiovascular outcomes for patients with prior MI. They compared outcomes and prescriptions for NSAIDs between 2002 through 2011. Aspirin was considered a separate therapy from NSAID use.

Among patients with at least one concomitant NSAID prescription, bleeding incident rates were about double those seen for patients without NSAID prescriptions (4.2 vs. 2.2 per 100 person years). Cardiovascular event rates were also higher among patients taking NSAIDs compared to those who were not (11.2 vs. 8.3 per 100 person years). Regardless of type of NSAID, duration of use or antithrombotic treatment type risk remained high for patients taking NSAIDs of either bleeding or a cardiovascular event (hazard ratio 2.02 and 1.4, respectively).

“Although it seems unlikely that physicians can completely avoid prescription of NSAIDs, even among high-risk patients, these results highlight the importance of considering the balance of benefits and risks before initiating any NSAID treatment,” wrote Olsen et al.

An editorial written by Charles L. Campbell, MD, of the University of Tennessee–Chattanooga, and David J. Moliterno, MD, of the University of Kentucky in Lexington, noted that bleeding and ischemic risks shown by Olsen et al were important to keep in mind when treating patients with a history of MI. “Because the present study tracked only prescription NSAID use, it is plausible that an even greater health care effect might occur in many countries, such as the United States, where NSAIDs are widely available as over-the-counter medications and physicians may be unaware whether their patients are taking NSAIDs,” they wrote.

In Denmark, only 200 mg ibuprofen is available over the counter; all other NSAIDs require a prescription.