NSAIDs in cardiac patients

Q: 56 years old male with history of chronic back pain is admitted to ICU from the cardiac cath lab after stents for coronary artery disease (CAD). Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in patients with recent cardiac events?

A) True

B) False

Answer: A

NSAIDs are well known for their relative contra-indication in renal insufficiency or acute kidney injury (AKI) in ICU. Unfortunately, their relative contra-indication in cardiac patients is not always as emphasized. 

NSAIDs should be avoided in patients with established CAD due to two reasons. These patients are usually on other anti-thrombotic drugs, such as aspirin or clopidogrel, which highly increases gastrointestinal (GI) bleeding risk. Secondly, NSAIDs can directly increase the risk of recurrent MI, ischemic stroke or transient ischemic attack (TIA), or systemic arterial embolism with an extremely high hazard ratio (HR) of almost 1:7

#cardiology

#pharmacology

References:

1. Kang DO, An H, Park GU, et al. Cardiovascular and Bleeding Risks Associated With Nonsteroidal Anti-Inflammatory Drugs After Myocardial Infarction. J Am Coll Cardiol 2020; 76:518.

2. Ray WA, Varas-Lorenzo C, Chung CP, et al. Cardiovascular risks of nonsteroidal antiinflammatory drugs in patients after hospitalization for serious coronary heart disease. Circ Cardiovasc Qual Outcomes 2009; 2:155.

3. Nissen SE, Yeomans ND, Solomon DH, et al. Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. N Engl J Med 2016; 375:2519.