Key result
Aspirin and dipyrone co-medication was associated with higher mortality compared to aspirin alone (24.4% vs 15.6%; HR 1.66, 95% CI 1.56-1.76, P<0.0001).
Why the study?
Dipyrone impairs the pharmacodynamic response to aspirin on platelet function tests, but whether this laboratory effect translates to clinical outcomes was unknown.
Does aspirin and dipyrone co-medication increase mortality and ischemic events in patients with cardiovascular disease on aspirin for secondary prevention?
Observational (n=32,146)
Yes
Does aspirin and dipyrone co-medication increase mortality and ischemic events in patients with cardiovascular disease on aspirin for secondary prevention?
Hazard Ratio: 1.66 (95% CI 1.56–1.76)
Absolute Event Rate: 24.4% vs 15.6%
p-value: p=<0.0001
Co-medication with dipyrone (metamizole) in patients taking aspirin for secondary cardiovascular prevention is associated with significantly increased mortality and ischemic events.
May warrant caution with dipyrone co-medication in aspirin users; leaves open causality pending randomized confirmation.
Background Pain is a major issue in our aging society. Dipyrone (metamizole) is one of the most frequently used analgesics. Additionally, it has been shown to impair pharmacodynamic response to aspirin as measured by platelet function tests. However, it is not known how this laboratory effect translates to clinical outcome. Methods and Results We conducted a nationwide analysis of a health insurance database in Germany comprising 9.2 million patients. All patients with a cardiovascular event in 2014 and subsequent secondary prevention with aspirin were followed up for 36 months. Inverse probability of treatment weighting analysis was conducted to investigate the rate of mortality, myocardial infarction, and stroke/transient ischemic attack between patients on aspirin‐dipyrone co‐medication compared with aspirin‐alone medication. Permanent aspirin‐alone medication was given to 26,200 patients, and 5946 patients received aspirin–dipyrone co‐medication. In the inverse probability of treatment weighted sample, excess mortality in aspirin–dipyrone co‐medicated patients was observed (15.6% in aspirin‐only group versus 24.4% in the co‐medicated group, hazard ratio [HR], 1.66 [95% CI, 1.56–1.76], P <0.0001). Myocardial infarction and stroke/transient ischemic attack were increased as well (myocardial infarction: 1370 [5.2%] versus 355 [5.9%] in aspirin‐only and co‐medicated groups, respectively; HR, 1.18 [95% CI, 1.05–1.32]; P =0.0066, relative risk [RR], 1.14; number needed to harm, 140. Stroke/transient ischemic attack, 1901 [7.3%] versus 506 [8.5%] in aspirin‐only and co‐medicated groups, respectively; HR, 1.22 [95% CI, 1.11–1.35]; P <0.0001, RR, 1.17, number needed to harm, 82). Conclusions In this observational, nationwide analysis, aspirin and dipyrone co‐medication was associated with excess mortality. This was in part driven by ischemic events (myocardial infarction and stroke), which occurred more frequently in co‐medicated patients as well. Hence, dipyrone should be used with caution in aspirin‐treated patients for secondary prevention.
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A 2021 study conducted an observational in Cardiovascular disease (n=32,146). Aspirin and dipyrone (metamizole) co-medication vs. Aspirin-alone medication was evaluated on Mortality (HR 1.66, 95% CI 1.56-1.76, p=<0.0001). Aspirin and dipyrone co-medication was associated with higher mortality compared to aspirin alone (24.4% vs 15.6%; HR 1.66, 95% CI 1.56-1.76, P<0.0001).
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