[How to watch over a patient treated with a NSAID in relation to the cardiovascular and renal risk?].
Despite the cardiovascular risk attributable to the NSAIDs, these drugs are among the most prescribed treatments in the world. Recently to manage this risk during chronic inflammatory rheumatisms a surveillance plan has been developed based on a decision algorithm. Given that the arterial thrombotic risks (myocardial or cerebral) are observed essentially during long-term treatments, two types of situation have been envisaged, short-term treatments and long-term treatments. Before any short-term NSAID prescription (less than one month), the cardio-renal risk should be evaluated. A pre-therapeutic check-up should include the search for risk factors and the treatment surveillance should imply a clinical and biological check-up carried out after 2 to 3 weeks of treatment. Before any long-term NSAID prescription (more than one month), the arterial thrombotic risk (cardiac or cerebral) should be evaluated and the patient's history determined. Pre-therapeutic check-up and surveillance should be carried out and reconsidered at least every three months. In the case of high risk the advice of a cardiologist or a nephrologist should be obtained and drastic therapeutic measures taken. There are cases where the prescription of NSAIDs or coxibs is possibly not recommended.
Schaeverbeke
Thierry
T
Service de Rhumatologie, CHU Pellegrin, Bordeaux 33000. thierry.schaeverbeke@chu-bordeaux.fr
Héloire
François
F
Deray
Gilbert
G
D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D003327:Coronary Disease / Q000139:chemically induced; D003401:Creatine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000139:chemically induced; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D020767:Intracranial Thrombosis / Q000139:chemically induced; D002546:Ischemic Attack, Transient / Q000139:chemically induced; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D003401:Creatine