Treatment with non-steroidal anti-inflammatory drugs in patients after myocardial infarction – a systematic review

ABSTRACT

Introduction: Studies over the past decade have shown that NSAIDs are associated with increased cardiovascular risk and may predispose to myocardial infarction in healthy individuals. Despite this knowledge patients with established cardiovascular disease are frequently treated with NSAIDs. The benefits versus potential harm of treatment need careful assessment.

Areas covered: Observational studies and clinical trials providing information about outcome of NSAID treatment in post MI patients were retrieved; fourteen articles in total: two case-control studies, two randomized double-blind trials and ten cohort studies. The studies had a follow-up time between 30 days and 15 years. Two studies reported of risk of atrial fibrillation, and only one addressed antithrombotic treatment.

Expert opinion: The risk of death and reinfarction in this group of patients is well established. Further studies are needed to investigate factors increasing the risk of atrial fibrillation. The correlation between recommended pharmaceutical treatment post MI and NSAIDs needs to be further examined. None of the studies examined correlated their results to dosages available over the counter.

KEYWORDS:

• Antithrombotic treatment
• atrial fibrillation
• myocardial infarction
• non-steroidal anti-inflammatory drugs
• reinfarction

Article highlights

• Studies over the past decade have demonstrated that NSAIDs predispose to myocardial infarction and death in patients with established cardiovascular disease.

• Being treated with NSAIDs at the time of admission due to an MI leads to poorer outcomes.

• Development of atrial fibrillation has been associated with use of NSAIDs in patients after an MI. Further studies of potential comorbidities could provide additional insights.

• Patients treated with NSAIDs and antithrombotic medication have an increased risk of gastrointestinal bleeding, which can be decreased with concomitant treatment with proton pump inhibitors.

• Research is needed focusing on adverse effects of dosages which are available OTC.

This box summarizes key points contained in this article.

Declaration of interests

G Gislason is supported by an unrestricted clinical research scholarship from Novo Nordisk Foundation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.