Nonsteroidal antiiinflammatory drugs (NSAIDs) may be associated with an increased risk of adverse cardiovascular events in certain patients. The risk can be seen not only with selective inhibitors of cyclooxygenase-2, but also with other classes of NSAIDs as well.


Risk factors for an adverse cardiovascular event in a patient taking NSAIDS:

(1) high doses of NSAIDs

(2) prolonged use (continuous or most days of the month)

(3) past history of an adverse cardiovascular event

(4) cigarette smoking

(5) other risk factors for cardiovascular disease (diabetes, hypertension, hypercholesterolemia, etc)

(6) concurrent therapy with a drug that interferes with NSAID metabolism


Some patients may take more than one NSAID, so it is important to ask about all medications including those taken over-the-counter.


It is important to ask patients with risk factors for cardiovascular disease about NSAID use. It is important to consider alternative therapies for management of pain that is chronic or severe.


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