Introduction
Non-Steroidal Anti-Inflammatory Drugs (NSAID) are frequently used in clinical practice, and are considered a first-line option for pain management. These drugs enhance platelets aggregation, by different mechanisms. Guidelines detail the importance of cardiovascular risk factors, and the risk for thrombosis, using these drugs.
Purpose
To raise awareness of cardiovascular adverse effects of NSAIDs in high risk cardiac patients.
Subjects and Methods
Patient 1: A 69-year-old female with hypertension, hyperlipidemia, long-time complaints of chest pain and dyspnea. The patient also suffered from lumbar discopathy and osteoarthritis, treated casually by NSAIDs (Betaren). In the week prior to admission, unlike usual, she took NSAID every day ,because of back pain. On the day of admission she complained of severe chest pain. At the out patient clinic, she lost her consciousness and was resuscitated, because of VF. STelevation acute anterior wall myocardial infraction was diagnosed. The patient was brought to the Cat. Lab, and underwent PCI to LAD.
Patient 2: A 62-year-old male with diabetes, hyperlipidemia and obesity and coronary artery disease since 2006 (at that time had PCI to RCA), and was free of symptoms , until recently.
Anginal pains had resumed , and he needed and passed coronary arteriography, with stent insertion to the right coronary artery (RCA) -diagnosed with 90% narrowing of RCA ,needed PCI with DES insertion. It should be noted ,that he was treated recently, daily, with Arcoxia (has not yet been approved by the FDA, for the US market).
Summary and Conclusions
These patients demonstrate the harmful effects of NSAIDs in high CV risk patients, and the need for better education, regarding the importance of avoiding the use of NSAIDs (which are available over the counter).
