한빛사 논문
Dong Oh Kang MDa,∗, Hyonggin An PhDb,∗, Geun U Park MSc, Yunjin Yum MSb, Eun Jin Park MDa, Yoonjee Park MDa, Won Young Jang MDd, Woohyeun Kim MDa, Jah Yeon Choi MDa, Seung-Young Roh MDa, Jin Oh Na MD, PhDa, Jin Won Kim MD, PhDa, Eung Ju Kim MD, PhDa, Seung-Woon Rha MD, PhDa, Chang Gyu Park MD, PhDa, Hong Seog Seo MD, PhDa, Cheol Ung Choi MD, PhDa
aCardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
bDepartment of Biostatistics, Korea University College of Medicine, Seoul, Korea
cLINEWALKS, Seoul, Korea
dDivision of Cardiology, Department of Internal Medicine, Catholic University of Korea St. Vincent’s Hospital, Suwon, Korea
*Drs. Kang and An contributed equally to this work.
Address for correspondence: Dr. Cheol Ung Choi, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea.
Abstract
Background
Limited data are available regarding the risk for adverse clinical events with concomitant nonsteroidal anti-inflammatory drug (NSAID) treatment after myocardial infarction (MI).
Objectives
The aim of this study was to investigate the risk for cardiovascular and bleeding events according to groups of antithrombotic medications and subtypes of NSAIDs in patients with MI.
Methods
This was a nationwide cohort study to enroll a study population from the Health Insurance Review and Assessment Service database in Korea between 2009 and 2013. Patients were divided into groups on the basis of the prescribed antithrombotic medications. The primary and secondary outcomes were thromboembolic cardiovascular and clinically relevant bleeding events. The risk for adverse clinical events was assessed by ongoing NSAID treatment and subtypes of NSAIDs.
Results
In total, 108,232 patients (mean age 64.2 ± 12.8 years, 72.1% men, mean follow-up duration 2.3 ± 1.8 years) with first diagnosed MI were enrolled. Concomitant NSAID treatment significantly increased the risk for cardiovascular events (hazard ratio [HR]: 6.96; 95% confidence interval [CI]: 6.24 to 6.77; p < 0.001) and bleeding events (HR: 4.08; 95% CI: 3.51 to 4.73; p < 0.001) compared with no NSAID treatment. Among NSAID subtypes, the risk for cardiovascular and bleeding events was lowest with the use of celecoxib (HR: 4.65; 95% CI: 3.17 to 6.82; p < 0.001, and 3.44; 95% CI: 2.20 to 5.39; p < 0.001, respectively) and meloxicam (HR: 3.03; 95% CI: 1.68 to 5.47; p < 0.001, and 2.80; 95% CI: 1.40 to 5.60; p < 0.001, respectively).
Conclusions
Concomitant NSAID treatment significantly increased the risk for cardiovascular and bleeding events after MI. Although NSAID treatment should be avoided after MI, celecoxib and meloxicam could be considered as alternative options in cases in which NSAID use is unavoidable.
Key Words : antithrombotic therapy; celecoxib; meloxicam; myocardial infarction; nonsteroidal anti-inflammatory drugs; safety
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