NEWS - MI risk spikes several weeks after stopping NSAIDs

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MI risk spikes several weeks after stopping NSAIDs

Rheumawire

December 14, 2004

Basel, Switzerland - A large case-control analysis has found that

there is a vulnerable period of several weeks after discontinuing

prolonged nonsteroidal anti-inflammatory drug (NSAID) therapy where

patients are at increased risk of acute myocardial infarction [1]. In

the December 13, 2004 issue of the Archives of Internal Medicine, Lorenz

Fischer (University Hospital Basel, Switzerland) and colleagues caution

against stopping NSAIDs abruptly.

Fischer et al found that the risk of MI was not elevated in

current NSAID users, suggesting that NSAIDs may counterbalance an

increased risk caused by inflammation. They point out that this

interpretation is contrary to previous studies reporting no effect of

current NSAID exposure on the risk of acute MI.

The researchers note that NSAIDs exert their effect by reversible,

competitive inhibition of cyclo-oxygenase, an important enzyme in the

regulation of molecular pathways of pain and inflammation. They point

out that in addition to COX inhibition, NSAIDs also decrease thromboxane

A2 production, potentially leading to an inhibition of platelet

aggregation.

Fischer and colleagues write that systemic inflammation is

associated with an increased risk of acute MI. However, the effect of

NSAIDs on the risk of MI has not yet been well defined. The researchers

sought to identify this risk during NSAID exposure and after cessation.

In their case-control analysis of the British General Practice Research

Database, they looked at more than 8600 cases of first-time acute MI and

33 923 controls, matched for age, sex, calendar time, and general

practice attended.

The investigators found that the risk of MI was highest in

subjects who stopped using NSAIDs after long-term exposure. The risk of

MI was also higher with recent discontinuation of NSAID use in subjects

with inflammatory diseases such as rheumatoid arthritis (RA) or systemic

lupus erythematosus (SLE).

Fischer and colleagues point out that the causes for the

association between stopping NSAIDs and the increased risk of MI are not

yet defined. " It may be the result of an inflammatory rebound effect in

the vascular tissue and/or the consequence of activated platelet

aggregation after termination of the pharmacological inhibition of COX

and thromboxane A2, " they explain.

" Our results suggest that abrupt discontinuation of NSAID therapy

may have to be avoided, " the researchers write. " Physicians should

carefully review the disease status and the current medication profile

before terminating a therapy with NSAIDs. This may be particularly valid

for patients with chronic inflammatory diseases and for subjects who

used NSAIDs for a long time. " They conclude that given the potential

clinical implications, these findings need to be confirmed by additional

studies.

Source

1. Fischer LM, Schlienger RG, Matter CM, et al.

Discontinuation of nonsteroidal anti-inflammatory drug therapy and risk

of acute myocardial infarction. Arch Intern Med 2004; 164:2472-2476.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org