How to Advise Aspirin Use in Patients Who Need NSAIDs

Abstract

NSAIDs are widely used all over the world. NSAID use is rising due to increasing availability without a prescription, use of aspirin for prevention of thrombotic disorders and the ageing population. Aspirin is used as an analgesic drug in many countries, but the main current indication is low-dose aspirin for the prevention of cardiovascular events. However, NSAIDs and aspirin use account for approximately 20-25% of all reported drug adverse events. Most of those are gastrointestinal including dyspepsia, hemorrhage, perforation and even death. The COX-2- selective inhibitors (coxibs) have demonstrated equivalent efficacy to nonspecific NSAIDs in the management of arthritis and pain but have less gastrointestinal adverse events, although coxibs and probably all NSAIDs, significantly increase risk of serious thromboembolic events. Concomitant use of low-dose aspirin is present in more than 20% of all patients taking either NSAIDs or coxibs, thus increasing the risk of gastrointestinal side effects. Furthermore, at present, it is not known whether aspirin decreases the cardiovascular risks of COX-2 inhibitors or NSAIDs. Appropriate strategies for gastrointestinal risk reduction with NSAIDs and aspirin must consider the overall health status of our patients including the presence of cardiovascular and gastrointestinal risk factors. Use of the lowest possible dose of these drugs, gastroprotectants, especially proton pump inhibitors and Helicobacter pylori eradication will reduce the risk of gastrointestinal side effects in patients taking low-dose aspirin and NSAIDs or coxibs.

Consumption of three most widely used analgesics in six European countries

“…Aspirin (acetylsalicylic acid) is used as an analgesic drug in many countries and together with other NSAIDs, it accounts for approximately 20–25% of overall reported drug adverse events. Most of these are gastrointestinal (GI) events, which include dyspepsia, mucosal injury and more serious events, such as ulcers, GI bleeding and perforation 5–7 . Therefore, the inappropriate use of drugs is a matter of interest to public health authorities, drug regulatory agencies and professional prescribers as well.…”

Topical nonsteroidal anti-inflammatory drugs for the treatment of pain due to soft tissue injury: diclofenac epolamine topical patch

“…Poor tolerability due to upper gastrointestinal symptoms, often categorized as dyspepsia, is a significant cause of treatment discontinuation 18. The prevalence of dyspepsia in patients treated with traditional NSAIDs can be high, ranging from 5%–50% 19. Due to the role of the COX-2 isoenzyme in renal prostaglandin biosynthesis, both traditional and selective NSAIDs are associated with renovascular AEs; risk may be increased in agents with a longer half-life 20,21…”

“…In a recent Internet survey of 1,000 general practitioners in the United States, 85% of providers indicated that more than 25% of their patients were taking aspirin for preventive reasons 84. The concomitant use of low-dose aspirin and oral NSAIDs has been associated with an increased risk of serious gastrointestinal AEs 19. Although the use of gastroprotective agents, such as proton pump inhibitors, appears to lower the risk of serious gastrointestinal AEs, not all patients on NSAID therapy receive these agents 84.…”

Pooled analysis of clinical trial data evaluating the safety and effectiveness of diclofenac epolamine topical patch 1.3% for the treatment of acute ankle sprain

“…Many patients with ankle sprains may also be taking low dose aspirin (LDA) or other antiplatet therapies for cardioprophylaxis, placing them at increased risk for GI events when NSAIDs are used 13. In addition, some commonly used NSAIDs, such as naproxen and ibuprofen, but not diclofenac, can have pronounced effects on the antiplatelet properties of LDA 14–18…”