A new study by Danish researchers shows non-steroidal anti-inflammatory drugs, or NSAIDs, used for pain management may increase the risk of cardiac arrest.
NSAID pain relievers are the most common over-the-counter medications used worldwide. NSAIDs have been found to influence platelet aggregation, cause blood clots, cause arteries to constrict, increase fluid retention and raise blood pressure.
“Allowing these drugs to be purchased without a prescription, and without any advice or restrictions, sends a message to the public that they must be safe,” Gunnar H. Gislason, a professor of cardiology at Copenhagen University Hospital Gentofte in Denmark, said in a press release. “Previous studies have shown that NSAIDs are related to increased cardiovascular risk which is a concern because they are widely used.”
Researchers reviewed medical records for 28,947 patients who had an out-of-hospital cardiac arrest between 2001 and 2010 and were part of the Danish Cardiac Arrest Registry. Researchers focused on the use of prescription NSAID pain relievers in 3,376 patients with cardiac arrest, which included diclofenac, naproxen and ibuprofen, and the COX-2 selective inhibitors rofecoxib and celecoxib. The use of over-the-counter medications was not evaluated because ibuprofen is the only over-the-counter NSAID approved in Denmark.
Researchers compared the use of NSAIDs during the 30 days before cardiac arrest to the use of NSAIDs during a preceding 30-day period without cardiac arrest.
The study showed the use of NSAIDs was associated with a 31 percent increased risk of cardiac arrest, while diclofenac had a 50 percent increased risk of cardiac arrest and ibuprofen showed a 31 percent increased risk. Naproxen, celecoxib and rofecoxib were not linked to an increased risk of cardiac arrest.
“The findings are a stark reminder that NSAIDs are not harmless,” Gislason said. “Diclofenac and ibuprofen, both commonly used drugs, were associated with significantly increased risk of cardiac arrest. NSAIDs should be used with caution and for a valid indication. They should probably be avoided in patients with cardiovascular disease or many cardiovascular risk factors.”
Gislason urged caution when using over-the-counter NSAID pain relievers.
“Over-the-counter NSAIDs should only be available at pharmacies, in limited quantities, and in low doses,” Gislason said. “Do not take more than 1,200 mg of ibuprofen per day. Naproxen is probably the safest NSAID and we can take up to 500 mg a day. Diclofenac is the riskiest NSAID and should be avoided by patients with cardiovascular disease and the general population. Safer drugs are available that have similar painkilling effects so there is no reason to use diclofenac.”
The study was published in European Heart Journal Cardiovascular Pharmacotherapy.