Current use of ketorolac was associated with the highest risk of acute myocardial infarction among 28 individual NSAIDs, with a meta-analytic odds ratio of 2.06 compared to past use of any NSAID.
Case-Control (n=8,535,952)
Sí
Does current use of individual NSAIDs increase the risk of acute myocardial infarction in adult new NSAID users compared to past use?
Current use of various individual NSAIDs, particularly ketorolac and certain coxibs, is associated with a significantly increased risk of acute myocardial infarction, correlating with COX-2 potency.
Estimación del efecto: OR 2.06 (95% CI 1.83-2.32)
BACKGROUND: Use of selective COX-2 non-steroidal anti-inflammatory drugs (NSAIDs) (coxibs) has been associated with an increased risk of acute myocardial infarction (AMI). However, the risk of AMI has only been studied for very few NSAIDs that are frequently used. OBJECTIVES: To estimate the risk of AMI for individual NSAIDs. METHODS: A nested case-control study was performed from a cohort of new NSAID users ≥18 years (1999-2011) matching cases to a maximum of 100 controls on database, sex, age, and calendar time. Data were retrieved from six healthcare databases. Adjusted odds ratios (ORs) of current use of individual NSAIDs compared to past use were estimated per database. Pooling was done by two-stage pooling using a random effects model (ORmeta) and by one-stage pooling (ORpool). RESULTS: Among 8.5 million new NSAID users, 79,553 AMI cases were identified. The risk was elevated for current use of ketorolac (ORmeta 2.06;95%CI 1.83-2.32, ORpool 1.80; 1.49-2.18) followed, in descending order of point estimate, by indometacin, etoricoxib, rofecoxib, diclofenac, fixed combination of diclofenac with misoprostol, piroxicam, ibuprofen, naproxen, celecoxib, meloxicam, nimesulide and ketoprofen (ORmeta 1.12; 1.03-1.22, ORpool 1.00;0.86-1.16). Higher doses showed higher risk estimates than lower doses. CONCLUSIONS: The relative risk estimates of AMI differed slightly between 28 individual NSAIDs. The relative risk was highest for ketorolac and was correlated with COX-2 potency, but not restricted to coxibs.
Masclee et al. (Thu,) conducted a case-control in Acute myocardial infarction risk in NSAID users (n=8,535,952). Individual NSAIDs (e.g., ketorolac, diclofenac, rofecoxib) vs. Past use of any NSAID was evaluated on Acute myocardial infarction (OR 2.06, 95% CI 1.83-2.32). Current use of ketorolac was associated with the highest risk of acute myocardial infarction among 28 individual NSAIDs, with a meta-analytic odds ratio of 2.06 compared to past use of any NSAID.
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