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Stroke Risk Linked To Painkiller Use

August 20, 2010

Researchers, in a new study, found that common painkillers that have been linked to risks of heart attack may also increase the risk of stroke.

Nearly 38,000 Taiwanese adults who suffered a stroke over one year, researchers found the use of a non-steroidal anti-inflammatory drug (NSAID) in the month prior to the stroke may have elevated that risk.

Results of the study were reported in the medical journal Stroke. Researchers said the increases linked to individual NSAID use were generally modest, and the findings do not prove that the medications themselves led to some people’s strokes.

NSAIDs include over-the-counter painkillers such as aspirin, ibuprofen and naproxen, as well as prescription arthritis drugs known as COX-2 inhibitors.

These inhibitors were first linked to an increased risk of heart attack and other cardiovascular ailments, and two of the drugs — Vioxx and Bextra — were pulled from the market in 2004 and 2005, respectively. Celebrex, another popular inhibitor, remains on the market.

Some of the older NSAIDs, including ibuprofen and diclofenac (Voltaren), have also raised concerns of experts about possible heart risks.

The new findings suggest that the “concern may also extend to the risk of stroke,” said Dr. Elliott Antman, professor of medicine at Harvard Medical School and Brigham and Women’s Hospital in Boston. Dr. Antman was not involved in the new study.

The results of the study do underscore the general recommendation that, to limit any cardiovascular risks, people should use NSAIDs at the lowest dose and for the shortest time necessary to relieve their pain, Antman added.

Dr. Chia-Hsuin Chang of National Taiwan University Hospital led the new study, which involved information from Taiwan’s national health insurance database. The team identified nearly 38,000 adults ages 20 and older who suffered a stroke in 2006. They then looked at the patients’ NSAID use in the month before the stroke and compared it to use in the prior three to six months.

The medications found included celecoxib, ibuprofen, naproxen, diclofenac and other oral NSAIDs. The team also found some that were given intravenously, such as ketorolac.

The team found that the use of any NSAID within the 30 days prior to the stroke was linked, in some way, to an increased risk of anywhere from 20 to 90 percent for most of the oral NSAIDs, depending on the drug. Oral ketorolac was linked to the greatest risk increase of 2.6-fold.

Antman said the last result needed to be interpreted cautiously because it was based on a small number of patients. Only 131 had used oral ketorolac in the month before their strokes. Researchers say the pattern was seen in patients with cardiovascular risk factors and those without.

Antman said it is important to keep in mind that the figures represent relative increases in risk. The absolute risk to any NSAID user may be quite small.

For instance, the National Institute of Neurological Disorders and Stroke estimates that adults in their 50s who are free of the major stroke risk factors have a 1 to 3 percent chance of suffering a stroke in the next decade.

So, even doubling such a person’s short-term stroke risk would still offer a very low absolute risk.

Antman said limiting use of NSAIDs is still a good idea, and especially important for people with established heart disease or its risk factors, such as high blood pressure and smoking.

The American Heart Association published guidelines in 2007 that recommend people to first try acetaminophen (Tylenol), which is not an NSAID, to ease their aches and pains. Although aspirin is an NSAID, it is still known to be protective against heart attacks and is recommended as well.

Antman noted that people should not continue to take NSAIDs beyond the recommended time shown on the label without talking with their doctor first. He added that common over-the-counter medications are still “real drugs that do have risks.”

It is thought that NSAIDs may contribute to heart problems or stroke for a few reasons, including effects that may make blood clots more likely to form or may create spikes in blood pressure.

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