6 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 1 6
How concerned should we be
about the potential for NSAIDs
to cause cardiovascular events?
As you probably know, the FDA
issued a strongly worded letter
(osmag.net/9bTEsW) last
summer, warning that NSAIDs
can cause heart attacks and
strokes. But the agency hasn't
said whether short-term use of NSAIDs is a significant concern.
The letter does clearly suggest that patients who've had cardiovascular issues — heart
attacks or strokes — might face greater risks. But the risk seems to be dose- and duration-
dependent. We haven't seen an increased risk with the short-term use of any of these drugs.
If you look closely at the potential side effects of the 3 approved IV NSAIDs — Toradol
(ketorolac), Caldolor (ibuprofen) and Dyloject (diclofenac) — all of which have COX-1 and COX-2
inhibiting properties, you'll find that ketorolac, which is more dominantly COX-1, would likely be
associated with more standard NSAID risks, like bleeding, GI irritation and kidney effects.
Ibuprofen and diclofenac, on the other hand, are more dominantly COX-2 and therefore might be
more likely to be associated with cardiovascular issues.
The bottom line is that clinicians should be aware of the potential risks, and should be selec-
tive about using all NSAIDs for longer periods of time and in patients who have a history of
heart-related issues. But short-term use of IV NSAIDs appears to be safe and effective in
patients who have acceptable risk profiles. — Eugene R. Viscusi, MD
The Link Between
NSAIDs And
Cardiovascular
Issues
DISHEARTENING?
Short-term use of IV NSAIDs appears
to be safe and effective in patients
who have acceptable risk profiles.
