NSAIDs may increase bleeding, CV events when combined with antiplatelet or anticoagulant agents post-MI

Nonsteroidal anti-inflammatory drugs (NSAIDs) were associated with increased risk of bleeding and thrombotic events, even during short-term treatment, among patients receiving antithrombotic therapy after myocardial infarction (MI), a study found.

Researchers studied 61,971 patients 30 years or older who were admitted with first-time MI and who were alive 30 days after discharge by using Danish registries of data from 2002 to 2011. Treatment with clopidogrel or oral anticoagulants and their combinations, as well as at least 1 NSAID, was examined. Results appeared in the Feb. 24 Journal of the American Medical Association.

During a median follow-up of 3.5 years, there were 18,105 deaths (29.2%), 5,288 bleeding events (8.5%), and 18,568 cardiovascular (CV) events (30%). The crude incidence rates of bleeding (events per 100 person-years) were 4.2 (95% CI, 3.8 to 4.6) with NSAID treatment and 2.2 (95% CI, 2.1 to 2.3) without NSAID treatment. The rates of CV events were 11.2 (95% CI, 10.5 to 11.9) with NSAIDs and 8.3 (95% CI, 8.2 to 8.4) without. The increased risk of bleeding and CV events happened with NSAIDs regardless of antithrombotic treatment, types of NSAIDs, or duration of use.

The researchers said that while more research is needed to confirm these findings, physicians should exercise appropriate caution when prescribing NSAIDs for patients who have recently experienced MI, even for treatment periods of 3 days or less.

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

The authors of an accompanying editorial voiced their concern that one-third of patients in the cohort were prescribed concomitant NSAIDs despite their recent MI.

They wrote, “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.”