Association of Short-Term Use of Nonsteroidal Anti-Inflammatory Drugs With Stroke in Patients With Hypertension

Abstract

Background and Purpose-Limited studies have investigated the risk of cerebrovascular events associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in subjects at high risk. We examined the short-term (defined as 30-day period) effect of selective and nonselective NSAIDs use on the risk of ischemic and hemorrhagic stroke in patients with hypertension. Methods-We conducted a case-crossover study using the National Health Insurance Research Database in Taiwan .).The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl

Non-steroidal anti-inflammatory drugs and risk of cerebrovascular events in patients with osteoarthritis: a nested case–control study

“…Our results are consistent with previous findings, showing that among traditional NSAIDs, diclofenac is characterized by a greater cerebrovascular risk [9][10][11]29]. Although our analysis does not demonstrate a statistically significant association with cerebrovascular events for aceclofenac and rofecoxib, their point estimates suggest a potential relationship.…”

“…The latter study also finds an increase in the risk of ischemic stroke for aceclofenac, and demonstrates that the risk of ischemic stroke, in particular, increases when NSAIDs are used at high dosages, over long-term duration, and in patients with cardiovascular risk factors [9]. Chuang et al find that nonselective NSAIDs, specifically diclofenac and ketorolac, significantly increase the risk of stroke, with the most frequent risk being ischemic stroke in light of a small number of cases of hemorrhagic events [29].…”

“…Nevertheless, few investigations have focused on cerebrovascular events [9][10][11]29]. Four studies included in a meta-analysis report an increased risk of ischemic stroke for diclofenac and rofecoxib, while an absence of risk is found for ibuprofen and naproxen [11].…”

Risk of Hemorrhagic Stroke in Patients Exposed to Nonsteroidal Anti-Inflammatory Drugs: A Meta-Analysis of Observational Studies

“…The date of the publication of the 13 studies was 1999 [20] to 2017 [17]. Five studies were conducted in Europe [20,24,26,27], 4 in Asia [17,[21][22][23], 3 in Australia [20,25,28], and 1 in North America [29]. The number of participants ranged from 134 to 4,354, and the total number of participants was 1,839,462.…”

“…To assess whether a single study had a substantial influence on the main results, we excluded each study consecutively and then evaluated its effect on the summary [18,19,[22][23][24]. Two studies estimated NSAIDs according to plasma half-life < 12 and > 12 h and the overall pooled RR 1.24 (95% CI 1.009-1.547, I 2 = 0.00, Q = 0.248) and RR 0.85 (95% CI 0.512-1.431, I 2 = 0.00, Q = 0.08) respectively [18,24].…”