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Comparatif de la toxicité
cardiovasculaire des AINS

Review Confirms CVD Risk With NSAIDS Rofecoxib, Diclofenac
Naproxen appeared to have a neutral risk

McGettigan P, Henry D. Cardiovascular risk with nonsteroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies.
PLoS Med 2011; [Texte complet]

That study, reported by heartwire , showed that cardiovascular risk was increased with diclofenac, indomethacin, and meloxicam as well as with rofecoxib. Naproxen was not cardioprotective, as had been previously suggested, but appeared to have a neutral risk, and results with ibuprofen were inconclusive.

Naproxen was consistently shown to be safe, even at high doses, suggesting it should be the NSAID of choice in patients with increased cardiovascular risk. Naproxen was shown to be safer than ibuprofen, with the risk of cardiovascular events increasing with ibuprofen at daily doses ranging from 1200 mg to 1600 mg.

If ibuprofen is used in high-risk patients, Henry said the dose should be kept low, but if a higher dose is needed, clinicians should switch to naproxen. Of the three NSAIDs available over the counter, ibuprofen and naproxen were safe at low doses, while diclofenac was associated with a 22% increase in risk at low doses.

Drugs and Pooled Relative Risks of Cardiovascular Events

Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis
BMJ 2011; 342:c7086
. Sven Trelle, senior research fellow12, Stephan Reichenbach, senior research fellow14, Simon Wandel, research fellow1, Pius Hildebrand, clinical reviewer3, Beatrice Tschannen, research fellow1, Peter M Villiger, head of department and professor of rheumatology4, Matthias Egger, head of department and professor of epidemiology and public health1, Peter Jüni, head of division and professor of clinical epidemiology12 + Author Affiliations

Cet article fait le point (méta-analyse), des effets cardiovasculaires de plusieurs AINS, le naproxène, l'ibuprofène, le diclofénac , le célécoxib , le rofécoxib et le lumiracoxib.Les effets cardiovasculaires pris en compte étaient l'infarctus du myocarde, les accidents vasculaires cérébraux, la mortalité de cause cardio-vasculaire, la mortalité toute cause confondues et les effets de type plaquettaire.
Comparés au placebo, les AINS dans leur ensemble ont des effets cardiovasculaires plutôt délétères, le moins nocif apparaît dans cette étude être le naproxène.

Voir également : Comparatif de la toxicité digestive des AINS [Lire]


Objective To analyse the available evidence on cardiovascular safety of non-steroidal anti-inflammatory drugs.

Design Network meta-analysis.
Data sources Bibliographic databases, conference proceedings, study registers, the Food and Drug Administration website, reference lists of relevant articles, and reports citing relevant articles through the Science Citation Index (last update July 2009). Manufacturers of celecoxib and lumiracoxib provided additional data.

Study selection All large scale randomised controlled trials comparing any non-steroidal anti-inflammatory drug with other non-steroidal anti-inflammatory drugs or placebo. Two investigators independently assessed eligibility.

Data extraction The primary outcome was myocardial infarction. Secondary outcomes included stroke, death from cardiovascular disease, and death from any cause. Two investigators independently extracted data.

Data synthesis 31 trials in 116?429 patients with more than 115?000 patient years of follow-up were included. Patients were allocated to naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib, or placebo.
Compared with placebo, rofecoxib was associated with the highest risk of myocardial infarction (rate ratio 2.12, 95% credibility interval 1.26 to 3.56), followed by lumiracoxib (2.00, 0.71 to 6.21). Ibuprofen was associated with the highest risk of stroke (3.36, 1.00 to 11.6), followed by diclofenac (2.86, 1.09 to 8.36). Etoricoxib (4.07, 1.23 to 15.7) and diclofenac (3.98, 1.48 to 12.7) were associated with the highest risk of cardiovascular death.

Conclusions Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Naproxen seemed least harmful. Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug.
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