Common painkillers increase stroke risk

Use of non-steroidal anti-inflammatory drugs (NSAIDs) such as celecoxib and diclofenac is associated with an increased risk of stroke, according to research published in the latest Medical Journal of Australia.

Dr Gillian Caughey, a researcher at the Quality Use of Medicines and Pharmacy Research Centre at the University of South Australia, and colleagues found that incident use of the drugs was associated with a 1.88 times increased risk of hospitalisation for stroke.

"This equates to an increased absolute risk of 13.4 strokes per 1000 people per year," Dr Caughey said.

The retrospective cohort study focused on 162 065 Australian veterans between 1 January 2001 and 31 December 2008 and found that the absolute risk of stroke was low. Dr Caughey said that "small increases in risk may be particularly important for older people, who commonly have comorbidities that are associated with increased risk of stroke".

"Significant positive associations between starting an NSAID and having a hospitalisation for stroke were found for most NSAIDs," Dr Caughey said.

The study found that the NSAIDs with the highest selectivity for cyclooxygenase-2 — rofecoxib (now withdrawn), celecoxib, meloxicam and diclofenac — were associated with an increased risk of stroke.

Dr Caughey urged "individual assessment of cardiovascular risk, careful deliberation of the balance between risk and benefits and appropriate supervision" when initiating NSAID therapy.

Associate Professor David Blacker, a neurologist at Sir Charles Gairdner Hospital and the University of Western Australia, has also urged caution in an accompanying MJA editorial, saying that while rofecoxib has been withdrawn, low-dose preparations of several NSAIDs are available in Australia without prescription.

"The findings of Caughey and colleagues further emphasise the need for great care in the use of these agents in patients with hypertension and other stroke risks," Associate Professor Blacker said.

(Source: Australian Medical Association: Medical Journal of Australia)

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