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Specific NSAIDs Increase Nonfatal Ischemic Stroke Risk

Use of diclofenac and aceclofenac, but not ibuprofen and naproxen, increases risk

THURSDAY, Feb. 12, 2015 (HealthDay News) -- Use of specific nonsteroidal anti-inflammatory drugs (NSAIDs), diclofenac and aceclofenac, is associated with increased risk of nonfatal ischemic stroke, according to a study published online Jan. 22 in the Journal of Thrombosis and Haemostasis.

Patricia García-Poza, Pharm.D., from the University of Alcalá in Madrid, and colleagues examined the risk of nonfatal ischemic stroke associated with NSAID and acetaminophen use. Data were included from 2,888 case patients, who were on treatment within a 30-day window before the index date, and 20,000 controls.

The researchers found that, overall, there was no increased risk with traditional NSAIDs as a group (odds ratio [OR], 1.03; 95 percent confidence interval [CI], 0.90 to 1.19). However, there was variation in results across individual agents and conditions of use. Diclofenac use correlated with increased risk (OR, 1.53), especially when used at high doses (OR, 1.62), over long-term periods (OR, 2.39 for more than 365 days), and in patients with high background cardiovascular risk (OR, 1.78). Aceclofenac also correlated with increased risk when used at high doses, long-term treatments, or in patients with cardiovascular risk factors (ORs, 1.67, 2.00, and 2.33, respectively). No correlation was seen for ibuprofen (OR, 0.94; 95 percent CI, 0.76 to 1.17) or naproxen (OR, 0.68; 95 percent CI, 0.36 to 1.29). There was no significant effect modification noted with concomitant aspirin use.

"Diclofenac and aceclofenac increase the risk of ischemic stroke while ibuprofen and naproxen do not," the authors write.

One author disclosed financial ties to AstraZeneca and Bayer.

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