Safety of nonsteroidal antiinflammatory drugs in patients with cardiovascular disease.
Nonsteroidal antiinflammatory drugs (NSAIDs) are used in the management of a variety of conditions, but their prevalence is likely underreported as a result of widespread availability and the perception that nonprescription therapies are unnecessary to report during medication history taking. However, NSAIDs are associated with a number of adverse effects, especially in patients with cardiovascular disease (CVD). Patients with CVD and comorbidities for which NSAIDs may provide symptomatic relief (e.g., osteoarthritis, rheumatoid arthritis) tend to be older, which places them at greater risk of harm. For these reasons, the use of NSAIDs in patients with CVD is a significant public health concern. An understanding of the risks associated with NSAIDs is critical for clinicians across practice settings. In this review, we detail the safety of NSAIDs in patients with CVD, provide recommendations on their use in specific disease states, and discuss therapeutic alternatives.
Department of Pharmacy, Mayo Clinic, Rochester, Minnesota.
Ilya M
IM
Danelich
Department of Pharmacy, Mayo Clinic, Rochester, Minnesota.
Sampaguita S
SS
Wright
Department of Pharmacy, Mayo Clinic, Rochester, Minnesota.
Jennifer M
JM
Lose
Department of Pharmacy, Mayo Clinic, Rochester, Minnesota.
Brittany J
BJ
Tefft
Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, North Carolina.
Jonathan D
JD
Cicci
Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland.
Brent N
BN
Reed
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000494:pharmacology; D000925:Anticoagulants / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000209:etiology / Q000503:physiopathology; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects; D004347:Drug Interactions; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D012306:Risk; D020521:Stroke / Q000209:etiology / Q000503:physiopathology; D013514:Surgical Procedures, Operative
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D016861:Cyclooxygenase Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
bleeding; cardiac surgery; cardiovascular disease; noncardiac surgery; nonsteroidal antiinflammatory drugs