止痛劑(NSAID)和心臟病(MI, ACS)

MEDICAL NEWS | PHYSICIAN'S FIRST WATCH
February 25, 2015
Study Highlights Risks with NSAID Use After Myocardial Infarction

雖然這已經不能算是新聞了，NSAID在心臟病患者(MI)身上，使用上要小心。

A JAMA study raises specific concerns about the safety of nonsteroidal anti-inflammatory drugs among people who've had a recent myocardial infarction. (NSAID Use With Antithrombotic Therapy After MI http://ja.ma/1LMlVVP)

Using data from national registries, Danish researchers studied over 60,000 people with a first MI, one third of whom received a prescription for an NSAID following discharge. Overall, NSAID users had double the rate of bleeding events as nonusers. In particular, people taking standard dual antiplatelet therapy with aspirin and clopidogrel had 3.3 bleeding events per 100 person-years; the addition of an NSAID increased this risk to 7.6 events per 100 person-years. Increased bleeding risks were found even when NSAIDs were used for 3 days or fewer.

因為MI後，可能會服用ASPIRIN或是CLOPIDOGREL，再加上NSAID，更會加重出血的機會，有些人甚至會增加血栓的機會。甚至，用3天短期的NSAID也會有這樣的結果。

In addition, the rate of cardiovascular events was increased by the addition of an NSAID to other drugs.

The authors note that NSAID use in people with established heart disease remains common, despite guidelines discouraging this practice.

然而目前的醫療上，NSAID使用在一些已經確診心臟病患者身上，是很常見的（因為NSAID止痛效果還是比ACETAMINOPHEN好啊），雖然心臟醫學會是反對這樣開藥的。

Editorialists conclude that for now, "practitioners would do well to advise patients with cardiovascular disease against all NSAID use (except low-dose aspirin), especially patients with a recent acute coronary syndrome."

結論：還是請大家儘量不要在心臟病患者，特別是近期有MI(ACS)患者身上使用NSAID，這樣才能趨吉避凶啊！