title: Analgesic medication with dipyrone in patients with coronary artery disease: Relation to MACCE.
abstract: BACKGROUND
  The non-opioid analgesic dipyrone can trigger life-threatening blood formation disorders. However, it is frequently used, as many patients with coronary artery disease (CAD) rely on non-opioid analgesics to relieve pain. In this study, we investigated the incidence of death, myocardial infarction (MI) or stroke in CAD patients with aspirin and dipyrone comedication as compared to aspirin-alone.
  
  
  METHODS
  We conducted an observational pilot study in 72 CAD patients with aspirin ± dipyrone comedication in the department of cardiology of the University Hospital Düsseldorf. The primary end point was a composite of death, myocardial infarction (MI) or stroke. The secondary end points were the components of the primary end point. The median follow-up period was 3.2years.
  
  
  RESULTS
  The primary end point occurred 67% of patients in the aspirin+dipyrone group as compared to 31% in the aspirin-alone group (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.7 to 12.3; P=0.0028;). All-cause mortality was significantly higher in the aspirin+dipyrone group (44%) than the aspirin-alone group (22%; OR 2.8, 95% CI 1.01 to 7.8; P=0.049). Ischemic events (MI and stroke) were more frequent in the aspirin+dipyrone group as compared to the aspirin alone group as well (OR 4, 95% CI 1.1 to 14; P=0.03).
  
  
  CONCLUSIONS
  In this hypothesis generating pilot analysis, dipyrone medication in aspirin treated coronary artery disease patients is associated with an increased cumulative incidence of death, MI or stroke as well as all-cause mortality and ischemic events. These data have to be confirmed in larger registries and trials.
  
  
  BACKGROUND
  http://clinicaltrials.gov/ct2/show/NCT01402804; Identifier: NCT01402804; Date of registration: July 25, 2011.
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Dusseldorf, Germany.
authors.forename: Alina
authors.initials: A
authors.lastname: Achilles
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Dusseldorf, Germany.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Mohring
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Dusseldorf, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Dannenberg
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Dusseldorf, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Piayda
authors.affiliation: Institute of Pathophysiology, West German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: Bodo
authors.initials: B
authors.lastname: Levkau
authors.affiliation: Institute for Pharmacology and Clinical Pharmacology, Heinrich Heine University, Dusseldorf, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hohlfeld
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Dusseldorf, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Zeus
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Dusseldorf, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Dusseldorf, Germany. Electronic address: Amin.polzin@med.uni-duesseldorf.de.
authors.forename: Amin
authors.initials: A
authors.lastname: Polzin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects; D001241:Aspirin / Q000008:administration & dosage*; D002637:Chest Pain / Q000188:drug therapy / Q000209:etiology; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D004177:Dipyrone / Q000008:administration & dosage / Q000009:adverse effects; D004347:Drug Interactions; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D010865:Pilot Projects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology*; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D010975:Platelet Aggregation Inhibitors; D004177:Dipyrone; D001241:Aspirin
keywords: Aspirin; Coronary artery disease; Dipyrone, drug interactions; Pharmacology