Do not add an NSAID to a patient on dual anti platelet therapy after a heart attack
It might boost bleeding risk, even if taken briefly as a painkiller.
Adding another NSAID atop recommended dual anti-platelet therapy with aspirin and clopidogrel in a study was associated with 2.41-fold higher risk of bleeding requiring hospitalization than the same regimen without an NSAID. The study led by Anne-Marie Schjerning Olsen, MD, PhD, of Copenhagen University Hospital is published in JAMA Feb issue.
The same was true for an NSAID added to a regimen of oral anticoagulants plus any other single anti-platelet drug.
The association with increased risk was observed for all antithrombotic treatment regimens, and the association was apparent regardless of whether selective COX-2 inhibitors (rofecoxib and celecoxib) or nonselective COX inhibitors (ibuprofen and diclofenac) were involved.
There was no safe therapeutic window for concomitant NSAID use, because even short-term (0-3 days) treatment was associated with increased risk of bleeding compared with no NSAID use.
Overall, receiving an NSAID versus no NSAID was associated with 40% higher risk of cardiovascular events and 2.02-fold higher risk of bleeding requiring hospitalization.
While NSAIDs can be helpful and at times necessary medications for satisfactory quality of life, use of these medications among patients with a history of a recent MI is likely to be associated with clinically meaningful bleeding and ischemic risks. [Source: MedPage]