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Are NSAIDS Lethal

Rob Orman, MD and Mel Herbert, MD MBBS FAAEM
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08:10
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Headline from The Guardian March 15, 2017: “Calls for ibuprofen sale restrictions after study finds cardiac arrest risk.” Is there now nothing that can be used for analgesia?!?

 

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Michael J. H., M.D. -

Aspirin remains still one of the most effective NSAIDS.

Troy C. -

This study is filled with holes and whether someone was actually using the medication in the previous 30 days is argumentative at best. From a general rule I am usually skeptical if you have to evaluate 30,000 people to find any difference. Also the concomitant use of ASA is not negligible regardless of the case control (406 of the 1721 - 24%) . It is has been shown that Ibuprofen interferes with and may negate the effects of low dose ASA therapy therefore not causing an event but effecting the therapeutic benefits of ASA. (1) Ibuprofen is a staple in non-narcotic pain management and this type of study only leads to fear without any causal relationship. I definitely would not recommend Ibuprofen in patients taking ASA for preventative therapy and would educate patients to seek medical treatment for chest pain and other mimicking symptoms of ACS but I don't think this study adds any substantial evidence to the growing thought process of eliminating Ibuprofen.

(1) Cyclooxygenase Inhibitors and the Antiplatelet Effects of Aspirin
Francesca Catella-Lawson, M.D., Muredach P. Reilly, M.D., Shiv C. Kapoor, Ph.D., Andrew J. Cucchiara, Ph.D., Susan DeMarco, R.N., Barbara Tournier, R.N., Sachin N. Vyas, Ph.D., and Garret A. FitzGerald, M.D.
N Engl J Med 2001; 345:1809-1817December 20, 2001DOI: 10.1056/NEJMoa003199

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Are NSAIDS Lethal? Full episode audio for MD edition 8:10 min - 7 MB - M4A