@article{c5abf845657847d89b6c4c3d559301cc,
title = "Cardiovascular and Bleeding Risks Associated With Nonsteroidal Anti-Inflammatory Drugs After Myocardial Infarction",
abstract = "Background: Limited data are available regarding the risk for adverse clinical events with concomitant nonsteroidal anti-inflammatory drug (NSAID) treatment after myocardial infarction (MI). Objectives: The aim of this study was to investigate the risk for cardiovascular and bleeding events according to groups of antithrombotic medications and subtypes of NSAIDs in patients with MI. Methods: This was a nationwide cohort study to enroll a study population from the Health Insurance Review and Assessment Service database in Korea between 2009 and 2013. Patients were divided into groups on the basis of the prescribed antithrombotic medications. The primary and secondary outcomes were thromboembolic cardiovascular and clinically relevant bleeding events. The risk for adverse clinical events was assessed by ongoing NSAID treatment and subtypes of NSAIDs. Results: In total, 108,232 patients (mean age 64.2 ± 12.8 years, 72.1% men, mean follow-up duration 2.3 ± 1.8 years) with first diagnosed MI were enrolled. Concomitant NSAID treatment significantly increased the risk for cardiovascular events (hazard ratio [HR]: 6.96; 95% confidence interval [CI]: 6.24 to 6.77; p < 0.001) and bleeding events (HR: 4.08; 95% CI: 3.51 to 4.73; p < 0.001) compared with no NSAID treatment. Among NSAID subtypes, the risk for cardiovascular and bleeding events was lowest with the use of celecoxib (HR: 4.65; 95% CI: 3.17 to 6.82; p < 0.001, and 3.44; 95% CI: 2.20 to 5.39; p < 0.001, respectively) and meloxicam (HR: 3.03; 95% CI: 1.68 to 5.47; p < 0.001, and 2.80; 95% CI: 1.40 to 5.60; p < 0.001, respectively). Conclusions: Concomitant NSAID treatment significantly increased the risk for cardiovascular and bleeding events after MI. Although NSAID treatment should be avoided after MI, celecoxib and meloxicam could be considered as alternative options in cases in which NSAID use is unavoidable.",
keywords = "antithrombotic therapy, celecoxib, meloxicam, myocardial infarction, nonsteroidal anti-inflammatory drugs, safety",
author = "Kang, {Dong Oh} and Hyonggin An and Park, {Geun U.} and Yunjin Yum and Park, {Eun Jin} and Yoonjee Park and Jang, {Won Young} and Woohyeun Kim and Choi, {Jah Yeon} and Roh, {Seung Young} and Na, {Jin Oh} and Kim, {Jin Won} and Kim, {Eung Ju} and Rha, {Seung Woon} and Park, {Chang Gyu} and Seo, {Hong Seog} and Choi, {Cheol Ung}",
note = "Funding Information: Previous studies have raised serious concerns about cardiovascular safety and increased bleeding risk with NSAID treatment after MI (8,9, 14–16). Most previous study results have been reported from large-scale registry data of Western patients with MI. There are currently no data focused primarily on this issue in patients with MI other than in Western populations, who are expected to have varying thromboembolic and bleeding characteristics (18–20). To the best of our knowledge, this is the first population-based study to investigate the cardiovascular and bleeding risk associated with concomitant NSAID treatment in a non-Western population with MI. Our study adds important value to the currently available evidence for concomitant NSAID treatment after MI by constituting global evidence that encompasses diverse population groups. The main advantage of the present study was its use of a nationwide prescription claims database that reflects real-world clinical practice treatment trends. Prescribing NSAIDs to patients with histories of MI is likely to cause potential harm; therefore, addressing the actual risk of NSAID treatment after MI is nearly impossible by randomized clinical trials because of ethical issues. The present study provides crucial evidence on subjects who are difficult to include in randomized clinical trials. Furthermore, the large study population of >100,000 patients strongly supports the generalizability of the results. The present study included the largest number of patients (n = 108,292) of any comparable clinical studies on NSAID treatment after MI thus far. Statistical analysis that defined NSAID treatment status as a time-varying covariate further strengthened the temporal relationship between NSAID treatment and adverse clinical events. Publisher Copyright: {\textcopyright} 2020 American College of Cardiology Foundation",
year = "2020",
month = aug,
day = "4",
doi = "10.1016/j.jacc.2020.06.017",
language = "English",
volume = "76",
pages = "518--529",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "5",
}