#JACCUpdate: NSAIDs increase bleeding risk after myocardial
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Use of NSAIDs to treat first-time heart attack patients significantly increased the risk for cardiovascular and bleeding events post-heart attack in a nationwide Korean study, published in the Journal of the American College of Cardiology.

The study enrolled 108,232 patients admitted for a first-time heart attack between 2009 and 2013, with a follow-up period of 2.3 years. The average age was 64.2 years and 72.1% were men. The researchers tracked prescriptions for antithrombotic medications (including aspirin, clopidogrel and oral vitamin K antagonist) and NSAIDs (including naproxen, ibuprofen, diclofenac, celecoxib, meloxicam and more). Among antithrombotic medications, dual antiplatelet therapy (DAPT) with aspirin and clopidogrel was the most frequently prescribed at 87.9%. Diclofenac was the most frequently prescribed NSAID in patients with either cardiovascular or bleeding event outcomes, 71.8% and 68.9%, respectively.

Cardiovascular and bleeding risk increased within seven days after patients began NSAIDs treatment. A primary cardiovascular event (including heart attack, stroke or blood clotting) developed in 26.2% of patients prescribed NSAIDs. Among the NSAIDs subtypes, celecoxib and meloxicam showed the lowest risk of cardiovascular events, with similar trends in the DAPT subgroup. Secondary bleeding events developed in 23.4% of patients. Like cardiovascular events, celecoxib, meloxicam and DAPT showed the lowest risk of bleeding events.

According to the researchers, NSAIDs treatment should be limited as much as possible after a heart attack, however the data suggests that celecoxib and meloxicam could be considered as a possible alternative choice in patients where NSAIDs prescription is inevitable. The trial demonstrated that cardiovascular risk increased significantly when patients were prescribed NSAIDs subtypes naproxen or ibuprofen.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0735109720355728?via=ihub
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