SOURCE: Olsen AMS, et al. JAMA 2015;313:805-814.

Most patients receive antiplatelet treatment after an acute coronary syndrome. Combinations of antiplatelet agents (e.g., ASA, clopidogrel) reduce risk of recurrent MI — particularly stent thrombosis — but do have a modest increase in bleeding risk. Well, what about our post-MI patients who are taking appropriately prescribed antiplatelet agents who also require treatment with NSAIDs for disorders like osteoarthritis, migraine, etc? How does such multidrug co-administration affect risks?

Olsen et al recently published results from data collected through Danish nationwide administrative registries that assessed bleeding events and cardiovascular events based on prescription data from 62,971 adults. The cohort evaluated included adults over age 30 (mean age = 68 years) who were admitted for a first MI in the 2002-2011 interval.

Rates of bleeding were doubled when NSAID users (that is, NSAIDS + antithrombotic treatment) were compared with non-users (that is, antithrombotic treatment alone). Equally concerning, the hazard ratio for cardiovascular (CV) events was 40% greater in NSAID users than non-users, irrespective of particular type of NSAID prescribed or duration of use.

This report should prompt clinician vigilance in post-MI patients taking antithrombotic therapy to limit the use of NSAIDs to the minimum necessary.