NSAIDs heighten risk for cardiovascular, bleeding risks after MI

Concomitant treatment with a nonsteroidal anti-inflammatory drug (NSAID) following myocardial infarction (MI) is associated with a higher risk of cardiovascular and bleeding events, a study has shown.

The authors investigated the risk for cardiovascular and bleeding events according to groups of antithrombotic medications and subtypes of NSAIDs. They accessed the Health Insurance Review and Assessment Service database between 2009 and 2013 and enrolled 108,232 patients (mean age, 64.2 years; 72.1 percent men) with first diagnosed MI in this nationwide cohort study.

Patients were then divided into groups based on their prescribed antithrombotic medications. Thromboembolic cardiovascular and clinically relevant bleeding events were the study outcomes. The risk for adverse clinical events were evaluated by ongoing NSAID treatment and subtypes of NSAIDs.

Over a mean follow-up of 2.3 years, concomitant NSAID treatment significantly elevated the risk for cardiovascular events (hazard ratio [HR], 6.96, 95 percent confidence interval [CI], 6.24–6.77; p<0.001) and bleeding events (HR, 4.08, 95 percent CI, 3.51–4.73; p<0.001) compared with no NSAID treatment.

Among NSAID subtypes, celecoxib and meloxicam showed the lowest risk for cardiovascular (celecoxib: HR, 4.65, 95 percent CI, 3.17–6.82; p<0.001 meloxicam: HR, 3.03, 95 percent CI, 1.68–5.47; p<0.001) and bleeding events (celecoxib: HR, 3.44, 95 percent CI, 2.20–5.39; p<0.001; meloxicam: HR, 2.80, 95 percent CI, 1.40–5.60; p<0.001).

“Although NSAID treatment should be avoided after MI, celecoxib and meloxicam could be considered as alternative options in cases in which NSAID use is unavoidable,” the authors said.