title: Cardiovascular Safety and Bleeding Risk Associated with Nonsteroidal Anti-Inflammatory Medications in Patients with Cardiovascular Disease.
abstract: Nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medications worldwide. There has been growing concern regarding the cardiovascular risks associated with NSAID use (both selective cyclooxygenase [COX]-2 inhibitors and nonselective NSAIDs). This review will examine the evidence pertaining to cardiovascular safety and bleeding risk related to nonaspirin NSAIDs.
  
  
  
  Earlier studies exposed the cardiovascular risks associated with use of selective COX-2 inhibitors; however, further studies have shown that even nonselective COX inhibition may lead to an increased risk of cardiovascular events. Data have also suggested that nonaspirin NSAIDs carry a higher bleeding risk in patients on antithrombotic therapy. Nonaspirin NSAIDs may confer an increased risk of both adverse cardiovascular outcomes and bleeding complications, regardless of COX selectivity and duration of use. Thus, it remains important to limit their use whenever possible, especially in patients with established cardiovascular disease.
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Ross
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Islam Y
authors.initials: IY
authors.lastname: Elgendy
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA. anthony.bavry@va.gov.|Medical Service, Cardiology Section (111D), North Florida/South Georgia Veterans Health System (Malcom Randall Veterans Administration Medical Center), 1601 SW Archer Road, Gainesville, FL, 32608, USA. anthony.bavry@va.gov.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Bavry
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors
keywords: Anti-inflammatory agents, nonsteroidal; Bleeding; Cardiovascular disease; Myocardial infarction; Stroke