GI and CVD risk with NSAIDs

GI and CVD risk with NSAIDs

In a related story, the Canadian Association of Gastroenterology Consensus Group has published guidelines on use of long-term NSAIDs in patients at risk for GI bleeding and cardiovascular disease. The guideline includes the recommendation that NSAIDs should always be used at the lowest effective dose for the shortest possible duration of treatment and that patients should be evaluated for the need for gastroprotective strategies and cardiovascular risk. For patients at low GI risk but high cardiovascular risk, the group recommends naproxen because of potentially lower cardiovascular risk than other NSAIDs or COX-2 inhibitors. For patients at high risk for GI side effects and low cardiovascular risk, a COX-2 inhibitor alone or traditional NSAIDs with a PPI offers similar protection. For patients at very high risk for GI bleeding, a COX-2 inhibitor plus a PPI is the safest option. In patients with both GI and cardiovascular risks, NSAIDs should be avoided if possible, but if anti-inflammatories are needed, and the patient is already on aspirin, the recommendations included naproxen plus a PPI if cardiovascular risk is the main concern or a COX-2 plus a PPI if GI side effects are the primary concern (Aliment Pharmacol Ther 2009;29:481-496).