Author + information
- Morten Lamberts,
- Gregory Lip,
- Morten Lock Hansen,
- Jesper Lindhardsen,
- Jonas Bjerring Olesen,
- Jakob Raunsø,
- Anne-Marie Schjerning Olsen,
- Emil L Fosbøl,
- Christian Torp-Pedersen and
- Gunnar Gislason
Whilst bleeding risk is assumed increased with widely used non-steroidal anti-inflammatory drugs (NSAID), the actual impact on serious bleeding complications in patients with atrial fibrillation (AF) is undefined. In real-life AF patients, we investigated the risk of serious bleeding and thromboembolism with ongoing NSAID and antithrombotic therapy.
Hospitalized non-valvular AF patients 1997-2009 were identified through nationwide registries. Ongoing NSAID and concomitant antithrombotic therapy was determined, and the risk of bleeding and thromboembolism was assessed in adjusted Cox regression models.
Of 131,106 included (mean age 73.4 years, 48% female), 17,476 (13.3%) used a NSAID during a mean follow-up of 3.9 years, with a total of 14,193 (10.8%) and 18,274 (13.9%) events of serious bleeding and thromboembolism, respectively. Risk of serious bleeding with NSAIDs was doubled (HR 2.11 [2.00-2.23]) compared to no NSAID treatment, and also with concomitant antithrombotic therapy (Figure). Risk of thromboembolism was also increased with NSAID use (HR 1.33 [1.25-1.41]). A poorer prognosis with exposure to NSAID at time of a nonfatal bleeding (HR 1.09 [1.04-1.16]) or thromboembolism episode (HR 1.09 [1.00-1.18]) was observed.
Use of NSAIDs is associated with a substantial risk of serious bleeding in AF patients, and confers no benefit on thromboembolism but results in harm. Physicians should exercise caution with NSAID use in AF patients.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Arrhythmias: AF/SVT II
Abstract Category: 24. Prevention: Clinical
Presentation Number: 1107-57
- 2013 American College of Cardiology Foundation