title: Cardiovascular and gastrointestinal safety of NSAIDs: a systematic review of meta-analyses of randomized clinical trials.
abstract: As part of the Safety of Non-Steroidal Anti-Inflammatory Drugs (SOS) Project, we reviewed the incidence of cardiovascular (CV) and gastrointestinal (GI) events associated with the use of this category of drugs. We collected data from published meta-analyses (MAs) of clinical trials of nonsteroidal anti-inflammatory drugs (NSAIDs). The Medline, Cochrane, ISI, and SCOPUS databases were systematically searched for MAs of NSAID clinical trials that could potentially contain data on adverse incidents such as myocardial infarction (MI), cerebrovascular events (CeVs), stroke, thromboembolic events (ThEs), heart failure (HF), gastrointestinal bleeding (GIB), and perforation, ulcer, and bleeding (PUB). From 1,733 identified references, 29 MAs were selected for the review. This allowed 109 estimations of incidence rates of CV adverse events and 26 estimations of incidence rates for GI adverse events. No data were found on hemorrhagic stroke or LGIB. Coxibs were studied in more MAs than traditional NSAIDs were (21 MAs for coxibs vs. 7 for traditional NSAIDs; one meta-analysis studied both). Many NSAIDs were not considered in any of the MAs. Our systematic review of MAs included information on the incidence of CV and GI events and identified important knowledge gaps regarding, in particular, the CV safety of traditional NSAIDs.
authors.affiliation: Département de Pharmacologie, Université de Bordeaux, Bordeaux, France. francesco.salvo@u-bordeaux2.fr
authors.forename: F
authors.initials: F
authors.lastname: Salvo
authors.forename: A
authors.initials: A
authors.lastname: Fourrier-Réglat
authors.forename: F
authors.initials: F
authors.lastname: Bazin
authors.forename: P
authors.initials: P
authors.lastname: Robinson
authors.forename: N
authors.initials: N
authors.lastname: Riera-Guardia
authors.forename: M
authors.initials: M
authors.lastname: Haag
authors.forename: A P
authors.initials: AP
authors.lastname: Caputi
authors.forename: N
authors.initials: N
authors.lastname: Moore
authors.forename: M C
authors.initials: MC
authors.lastname: Sturkenboom
authors.forename: A
authors.initials: A
authors.lastname: Pariente
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000453:epidemiology; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic / Q000379:methods
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal