title: Stroke risk and NSAIDs: an Australian population-based study.
abstract: OBJECTIVE
  To determine the risk of stroke associated with non-steroidal anti-inflammatory drug (NSAID) use.
  
  
  METHODS
  Retrospective cohort study of 162,065 Australian veterans with incident dispensing of an NSAID between 1 January 2001 and 31 December 2008, using prescription event sequence symmetry analysis.
  
  
  METHODS
  Hospitalisation for stroke, ischaemic stroke or haemorrhagic stroke.
  
  
  RESULTS
  The absolute risk of stroke was low: 7.1/1000 people/year. Incident use of NSAIDs was associated with a 1.88 times increased risk (95% CI, 1.70-2.08) of hospitalisation for stroke (ischaemic or haemorrhagic) following first ever dispensing of an NSAID. This equates to an increased absolute risk of 13.4 strokes/1000 people/year. Significant positive associations between starting an NSAID and having a hospitalisation for stroke were found for most NSAIDs, with adjusted sequence ratios ranging from 1.44 (95% CI, 1.16-1.80) for indomethacin to 1.80 (95% CI, 1.59-2.04) for rofecoxib.
  
  
  CONCLUSIONS
  Incident use of NSAIDs was associated with an increased risk of stroke. Increased awareness of the potential for serious adverse cardiovascular events, together with individual assessment of cardiovascular risk, careful deliberation of the balance between risk and benefits and appropriate supervision, is required when initiating NSAID therapy.
authors: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, University of South Australia, Adelaide, SA. gillian.caughey@unisa.edu.au
authors: Gillian E
authors: GE
authors: Caughey
authors: Elizabeth E
authors: EE
authors: Roughead
authors: Nicole
authors: N
authors: Pratt
authors: Graeme
authors: G
authors: Killer
authors: Andrew L
authors: AL
authors: Gilbert
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001315:Australia / Q000453:epidemiology; D002545:Brain Ischemia / Q000139:chemically induced / Q000453:epidemiology; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects*; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors