Preadmission use of nonaspirin nonsteroidal anti-inflammatory drugs and 30-day stroke mortality.
OBJECTIVE
To examine whether preadmission use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) influenced 30-day stroke mortality.


METHODS
We conducted a nationwide population-based cohort study. Using medical databases, we identified all first-time stroke hospitalizations in Denmark between 2004 and 2012 (n = 100,043) and subsequent mortality. We categorized NSAID use as current (prescription redemption within 60 days before hospital admission), former, and nonuse. Current use was further classified as new or long-term use. Cox regression was used to compute hazard ratios (HRs) of death within 30 days, controlling for potential confounding through multivariable adjustment and propensity score matching.


RESULTS
The adjusted HR of death for ischemic stroke was 1.19 (95% confidence interval [CI]: 1.02-1.38) for current users of selective cyclooxygenase (COX)-2 inhibitors compared with nonusers, driven by the effect among new users (1.42, 95% CI: 1.14-1.77). Comparing the different COX-2 inhibitors, the HR was driven by new use of older traditional COX-2 inhibitors (1.42, 95% CI: 1.14-1.78) among which it was 1.53 (95% CI: 1.02-2.28) for etodolac and 1.28 (95% CI: 0.98-1.68) for diclofenac. The propensity score-matched analysis supported the association between older COX-2 inhibitors and ischemic stroke mortality. There was no association for former users. Mortality from intracerebral hemorrhage was not associated with use of nonselective NSAIDs or COX-2 inhibitors.


CONCLUSIONS
Preadmission use of COX-2 inhibitors was associated with increased 30-day mortality after ischemic stroke, but not hemorrhagic stroke. Use of nonselective NSAIDs at time of admission was not associated with mortality from ischemic stroke or intracerebral hemorrhage.
From the Departments of Clinical Epidemiology (M.S., E.H.-P., C.F.C., H.T.S.) and Cardiology (M.S., H.E.B.), Aarhus University Hospital, Denmark; and California Pacific Medical Center Research Institute (M.S., K.L.P.), San Francisco. morten.schmidt@clin.au.dk.
Morten
M
Schmidt
From the Departments of Clinical Epidemiology (M.S., E.H.-P., C.F.C., H.T.S.) and Cardiology (M.S., H.E.B.), Aarhus University Hospital, Denmark; and California Pacific Medical Center Research Institute (M.S., K.L.P.), San Francisco.
Erzsébet
E
Hováth-Puhó
From the Departments of Clinical Epidemiology (M.S., E.H.-P., C.F.C., H.T.S.) and Cardiology (M.S., H.E.B.), Aarhus University Hospital, Denmark; and California Pacific Medical Center Research Institute (M.S., K.L.P.), San Francisco.
Christian Fynbo
CF
Christiansen
From the Departments of Clinical Epidemiology (M.S., E.H.-P., C.F.C., H.T.S.) and Cardiology (M.S., H.E.B.), Aarhus University Hospital, Denmark; and California Pacific Medical Center Research Institute (M.S., K.L.P.), San Francisco.
Karin L
KL
Petersen
From the Departments of Clinical Epidemiology (M.S., E.H.-P., C.F.C., H.T.S.) and Cardiology (M.S., H.E.B.), Aarhus University Hospital, Denmark; and California Pacific Medical Center Research Institute (M.S., K.L.P.), San Francisco.
Hans Erik
HE
Bøtker
From the Departments of Clinical Epidemiology (M.S., E.H.-P., C.F.C., H.T.S.) and Cardiology (M.S., H.E.B.), Aarhus University Hospital, Denmark; and California Pacific Medical Center Research Institute (M.S., K.L.P.), San Francisco.
Henrik Toft
HT
Sørensen
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D001241:Aspirin; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D010343:Patient Admission / Q000639:trends*; D011159:Population Surveillance / Q000379:methods; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality*; D013997:Time Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin