- NSAIDS are used therapeutically most often as anti-inflammatory agents in
conditions of inflammation and pain, mostly of a non-urologic nature.
- A
meta-analysis of primarily short-term trials found that all NSAIDs except naproxen
were associated with similar increased risks of heart attack compared with
placebo in elderly patient.1
- Naproxen may be a better choice for
people who have higher risk of heart attacks or strokes, since the available
evidence indicates it does not increase the risk of these conditions.
- It is important to consider the duration and frequency of therapy
of NSAIDS if patient is having risk of cardiovascular disease. (short duration
therapy can be opt for patient at risk of cardiovascular disease)
- The risk of adverse cardiovascular
events such as myocardial infarction, stroke, or cardiovascular death is
extremely small over a short course of therapy, as might be used for patients
with an acute but limited musculoskeletal injury.1
- The American Heart
Association recommends a “stepped care” approach to medication therapy for
people with CVD who have musculoskeletal aches and pains. A person would be
started on medications that have the lowest reported risk for cardiovascular
events, and then, if needed, move step by step to other medications, with
consideration of the risks versus the benefits at each step.2
- Start with OTC medications acetaminophen or aspirin, the
prescription medication tramadol, or short-term painkillers containing a
narcotic. If necessary, go to
- Aspirin-like drugs (nonacetylated salicylates). If
necessary, go to
- Non-COX-2 selective NSAIDs. If necessary, go to
- NSAIDs with some COX-2 activity. If necessary, go to
- COX-2 selective NSAIDs.
Reference
- http://consumerhealthchoices.org/wp-content/uploads/2012/02/BBD-NSAIDs-Full.pdf
- http://www.health.harvard.edu/blog/fda-strengthens-warning-that-nsaids-increase-heart-attack-and-stroke-risk-201507138138
- http://www.medscape.com/viewarticle/856762
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