Certain Painkillers Tied to Raised Risk of Death After Stroke

Celebrex and other COX-2 inhibitors should be prescribed with care, experts say

Steven Reinberg

Steven Reinberg

Published on November 05, 2014

WEDNESDAY, Nov. 5, 2014 (HealthDay News) -- Arthritis pain relievers known as COX-2 inhibitors, including Celebrex and Lodine, are associated with an increased risk of dying within a month after a stroke, according to a new study.

"This large study from Denmark adds to the prior concerns about COX-2 inhibitors and stroke risks," said Dr. Ralph Sacco, chairman of neurology at the University of Miami Miller School of Medicine.

"Patients at high risk for stroke should be cautious about taking such medications and should consult their physicians as to the best medications to treat inflammation and pain," Sacco said.

However, while the study found an association between use of these painkillers and death in stroke patients, it did not prove cause-and-effect.

Other types of nonsteroidal anti-inflammatory painkillers (NSAIDs) -- including ibuprofen (Advil, Motrin) and naproxen (Aleve) -- weren't linked to an increased risk of death after stroke, the study authors said.

COX-2 inhibitors have previously been linked to an increased risk for both heart attack and stroke. In 2004, Merck pulled the popular painkiller Vioxx from the market because of this association.

The next year, the U.S. Food and Drug Administration asked Pfizer to voluntarily stop selling Bextra (valdecoxib) because of its link with an increased risk of heart attack and stroke.

Celebrex (celecoxib), however, which is in the same class of drugs and also made by Pfizer, remains on the market.

In the new study -- based on more than 100,000 people hospitalized for a first stroke between 2004 and 2012-- the investigators wanted to see if the painkillers affected recovery from a stroke.

The researchers found that use of Celebrex prior to hospitalization for ischemic stroke was associated with a 19 percent increase in risk of death within a month, compared with non-use of the drug.

Ischemic stroke, the most common type of stroke, is caused by a clot that blocks blood flow to the brain.

"Much of this result came from new users of the drugs, who were 42 percent more likely to die from stroke than those who were not taking the drugs," said lead researcher Dr. Morten Schmidt, the cardiovascular research coordinator at Aarhus University Hospital.

"The results were also stronger for those taking the older COX-2 inhibitors," he added.

The older drugs -- for example, Lodine (etodolac) -- raised the risk of dying from stroke by 53 percent, the researchers reported.

The report was published in the Nov. 5 online edition of the journal Neurology.

Of the more than 100,000 stroke patients the researchers looked at, 11 percent used painkillers prior to admission and 8 percent were former users.

"There are several cardiovascular risks to consider when prescribing NSAIDs, in particular COX-2 inhibitors," Schmidt said.

"Efforts should be made to ensure people with a higher risk of stroke are not prescribed these medications when other options are available," he said.

More information

For more about stroke, visit the U.S. National Library of Medicine.

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