Tuesday, 23 Apr 2019

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Low Short-Term Risks of NSAIDs in High Risk Patients

JAMA has published a large Canadian claims-based study showing that nonsteroidal anti-inflammatory drug (NSAID) use in patients with hypertension, heart failure, or chronic kidney disease was not associated with a significant safety risk - but this only looked at short-term outcomes (7-37 days of exposure). 

A study of 2,415,291 musculoskeletal-related primary care visits and 814,049 older adults (mean age 75.3 years) who also had hypertension, heart failure, or CKD, found that nearly 10% were prescribed NSAID therapy.

A match cohort analysis (35 552 matched pairs of NSAID exposed and nonexposed) showed similar rates of cardiac complications (0.8% vs 0.8%), renal complications (0.1% vs 0.1%), and death (0.1% vs 0.1%).

Thus, even though NSAIDs were frequently used in high-risk patients, NSAID exposure was not associated with increased risk of short-term, safety-related outcomes.

The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

Unfortunately, this data can be misinterpreted. In clinical practice painful conditions are not usually acute and short-term (exceptly secondary to overuse/ trauma). Instead it is not uncommon to be chronic and recurrent. Therefore, although short-term NSAIDs use appears to be safe in CKD, heart failure, and hypertension patients, its recurrent use can not be considered safe. I believe that, just like opioid abuse, anti-inflammatory abuse should be tackled and even if it proves to be safe in some situations, its use should be discouraged through constant patient education, reinforcing them to not “autoprescribe” NSAIDs.

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