More than a pain: NSAIDs may raise VTE risk

Non-steroidal anti-inflammatory drugs (NSAIDs) may be good for what hurts, but they also could be setting patients up for pulmonary embolism. Venous thromboembolism (VTE) risk was increased in patients on NSAIDs, according to a study published Sept. 29 in Rheumatology.

Lead author Patompong Ungprasert, MD, of Bassett Medical Center and Columbia University College of Physicians and Surgeons in Cooperstown, N.Y., and colleagues performed a meta-analysis on six studies that reported outcomes of patients taking NSAIDs.

They noted that in the past, some NSAIDs, such as rofecoxib (Vioxx, Merck) had been taken off the market due to increased risk of MI and sudden cardiac death. Ungprasert et al wrote that arterial and venous thrombosis have shared biological mechanisms and may, therefore, place patients at increased risks for VTE.

Analysis was performed to determine general risk and also the risk inherent in a subset of NSAIDs that are COX-2 inhibitors. Relative heterogeneity was seen in the six studies analyzed and subjects were predominantly pulled from hospitalized patients, although three studies also included ambulatory patients.

The research team found a combined risk for VTE for patients on NSAIDs was 1.8. COX-2 inhibiting NSAIDs revealed an increased risk for users of 1.99.

Because this was a meta-analysis, Ungprasert et al could not establish a direct effect to NSAIDs on outcomes, merely an association, and they did not rule out other potential confounders that increased patients’ risks for VTE. Also, no one NSAID was assessed specifically for increased risks and therefore none could be ruled in or out as being more or less likely to be problematic.

Ungprasert et al wrote “Physician[s] should be aware of this association and NSAIDs should be prescribed with caution, especially in patients at high baseline risk of VTE.”