下面這篇是台大的研究. 使用健保資料庫研究口服或注射 NSAID 非類固醇消炎止痛藥. 與新發生急性心肌梗塞住院患者的關聯性.
Abstract
Background
Previous studies have documented the increased cardiovascular risk associated with the use of some nonsteroidal anti-inflammatory drugs (NSAIDs). Despite this, many old NSAIDs are still prescribed worldwide. Most of the studies to date have been focused on specific oral drugs or limited by the number of cases examined. We studied the risk of new acute myocardial infarction (AMI) hospitalization with current use of a variety of oral and parenteral NSAIDs in a nationwide population, and compared our results with existing evidence.
Methods
We conducted a case-crossover study using the Taiwan's National Health Insurance claim database, identifying patients with new AMI hospitalized in 2006. The 1-30 days and 91-120 days prior to the admission were defined as case and matched control period for each patient, respectively. Uses of NSAIDs during the respective periods were compared using conditional logistic regression and adjusted for use of co-medications.
Results
8354 new AMI hospitalization patients fulfilled the study criteria. 14 oral and 3 parenteral NSAIDs were selected based on drug utilization profile among 13.7 million NSAID users. The adjusted odds ratio, aOR (95% confidence interval), for risk of AMI and use of oral and parenteral non-selective NSAIDs were 1.42 (1.29, 1.56) and 3.35 (2.50, 4.47), respectively, and significantly greater for parenteral than oral drugs (p for interaction < 0.01). Ketorolac was associated with the highest AMI risk among both of oral and parenteral NSAIDs studied, the aORs were 2.02 (1.00, 4.09) and 4.27 (2.90, 6.29) respectively. Use of oral flurbiprofen, ibuprofen, sulindac, diclofenac, and parenteral ketoprofen were also significantly associated with increased AMI risk. The results of the present study were consistent with the majority of evidence from previous studies.
Conclusions
The collective evidence revealed the tendency of increased AMI risk with current use of some NSAIDs. A higher AMI risk associated with use of parenteral NSAIDs was observed in the present study. Ketorolac had the highest associated risk in both oral and parenteral NSAIDs studied. Though further investigation to confirm the association is warranted, prescribing physicians and the general public should be cautious about the potential risk of AMI when using NSAIDs.
Background
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used medications for reducing inflammation and relief pain. Due to large population exposed to NSAIDs, the risk of serious adverse cardiovascular effect for patient taking NSAIDs is an area of concern, from both a clinical and public health perspective [1-9]. Despite the frequent prescription of a wide variety of old oral and parenteral NSAIDs, recent studies exploring links between cardiovascular risk and NSAIDs use, including randomized controlled trials and observational studies, had mostly focused on cyclooxygenase-2 selective inhibitors (COX-2) or some non-selective NSAIDs (ns-NSAIDs), and were limited by the number of cases examined [1-3,10-12]. The assessment of the risk of acute myocardial infarction (AMI) from the use of parenteral NSAIDs was not a focus of the studies. The aim of this study was to assess the risk of hospitalization due to AMI as a result of the use of a variety of oral and parenteral NSAIDs in outpatient-clinic settings, and to compare the results with existing evidence.
