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Review
. 2017 Jun;8(6):173-182.
doi: 10.1177/2042098617690485. Epub 2017 Feb 10.

Cardiovascular and cerebrovascular risk with nonsteroidal anti-inflammatory drugs and cyclooxygenase 2 inhibitors: latest evidence and clinical implications

Andrea Fanelli  1 , Daniela Ghisi  2 , Pierangelo Lora Aprile  3 , Francesco Lapi  4
Affiliations
Review

Cardiovascular and cerebrovascular risk with nonsteroidal anti-inflammatory drugs and cyclooxygenase 2 inhibitors: latest evidence and clinical implications

Andrea Fanelli et al. Ther Adv Drug Saf. 2017 Jun.

Abstract

Observational studies and meta-analyses have shown that the administration of nonsteroidal anti-inflammatory drugs (NSAIDs), especially when prescribed at high doses for long periods of time, can potentially increase the risk of cardiovascular diseases. The increased thrombotic risk related to the use of NSAIDs is mainly due to their cyclooxygenase 2 selectivity. The dosage use, the formulation selected and the duration of the therapy are other factors that can significantly impact on the cardiovascular risk. In order to minimize the risk, prescription of the right drug based on the patient's features and the different safety profiles of several NSAIDs that are available on the market is key for their appropriate administration. Despite the baseline cardiovascular and gastrointestinal risk of each patient, monitoring of patients is suggested for increases in blood pressure, development of edema, deterioration of renal function, or gastrointestinal bleeding during long-term treatment with NSAIDs.

Keywords: cardiovascular risk; cerebrovascular risk; cyclooxygenase 2 inhibitors; nonsteroidal anti-inflammatory drugs; paracetamol.

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Conflict of interest statement

Conflict of interest statement: A. Fanelli has served as a speaker for IBSA, as a consultant for Abbvie, Angelini and Molteni and as an advisory board member for Grunenthal. F. Lapi provided consultations in protocol preparation for epidemiological studies and data analyses for IBSA and Angelini. P.A. Lora Aprile provided clinical consultations for IBSA, Angelini, Alfa Wasserman, Pfizer, ProStrakan and Molteni. D. Ghisi has no conflicts of interest to disclose.

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