Cardiovascular and Bleeding Risks Associated With Nonsteroidal Anti-Inflammatory Drugs After Myocardial Infarction

Dong Oh Kang, Hyonggin An, Geun U. Park, Yunjin Yum, Eun Jin Park, Yoonjee Park, Won Young Jang, Woohyeun Kim, Jah Yeon Choi, Seung Young Roh, Jin Oh Na, Jin Won Kim, Eung Ju Kim, Seung Woon Rha, Chang Gyu Park, Hong Seog Seo, Cheol Ung Choi

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: Limited data are available regarding the risk for adverse clinical events with concomitant nonsteroidal anti-inflammatory drug (NSAID) treatment after myocardial infarction (MI). Objectives: The aim of this study was to investigate the risk for cardiovascular and bleeding events according to groups of antithrombotic medications and subtypes of NSAIDs in patients with MI. Methods: This was a nationwide cohort study to enroll a study population from the Health Insurance Review and Assessment Service database in Korea between 2009 and 2013. Patients were divided into groups on the basis of the prescribed antithrombotic medications. The primary and secondary outcomes were thromboembolic cardiovascular and clinically relevant bleeding events. The risk for adverse clinical events was assessed by ongoing NSAID treatment and subtypes of NSAIDs. Results: In total, 108,232 patients (mean age 64.2 ± 12.8 years, 72.1% men, mean follow-up duration 2.3 ± 1.8 years) with first diagnosed MI were enrolled. Concomitant NSAID treatment significantly increased the risk for cardiovascular events (hazard ratio [HR]: 6.96; 95% confidence interval [CI]: 6.24 to 6.77; p < 0.001) and bleeding events (HR: 4.08; 95% CI: 3.51 to 4.73; p < 0.001) compared with no NSAID treatment. Among NSAID subtypes, the risk for cardiovascular and bleeding events was lowest with the use of celecoxib (HR: 4.65; 95% CI: 3.17 to 6.82; p < 0.001, and 3.44; 95% CI: 2.20 to 5.39; p < 0.001, respectively) and meloxicam (HR: 3.03; 95% CI: 1.68 to 5.47; p < 0.001, and 2.80; 95% CI: 1.40 to 5.60; p < 0.001, respectively). Conclusions: Concomitant NSAID treatment significantly increased the risk for cardiovascular and bleeding events after MI. 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.

Original languageEnglish
Pages (from-to)518-529
Number of pages12
JournalJournal of the American College of Cardiology
Volume76
Issue number5
DOIs
Publication statusPublished - 2020 Aug 4

Keywords

  • antithrombotic therapy
  • celecoxib
  • meloxicam
  • myocardial infarction
  • nonsteroidal anti-inflammatory drugs
  • safety

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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