Cardiovascular Safety and Bleeding Risk Associated with Nonsteroidal Anti-Inflammatory Medications in Patients with Cardiovascular Disease

Purpose of Review: Nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medications worldwide. There has been growing concern regarding the cardiovascular risks associated with NSAID use (both selective cyclooxygenase [COX]-2 inhibitors and nonselective NSAIDs). This review will examine the evidence pertaining to cardiovascular safety and bleeding risk related to nonaspirin NSAIDs. Recent Findings: Earlier studies exposed the cardiovascular risks associated with use of selective COX-2 inhibitors; however, further studies have shown that even nonselective COX inhibition may lead to an increased risk of cardiovascular events. Data have also suggested that nonaspirin NSAIDs carry a higher bleeding risk in patients on antithrombotic therapy. Summary: Nonaspirin NSAIDs may confer an increased risk of both adverse cardiovascular outcomes and bleeding complications, regardless of COX selectivity and duration of use. Thus, it remains important to limit their use whenever possible, especially in patients with established cardiovascular disease.