Most Read Articles
04 Oct 2018
A week of preoperative oral antibiotics prior to percutaneous nephrolithotomy does not appear to confer any benefit in patients at low risk for infectious complications, suggests a recent study. Perioperative antibiotics according to the American Urological Association (AUA) Best Practice Statement is deemed sufficient.
09 Oct 2018
The use of statins does not appear to influence the immature platelet count in patients with coronary artery disease (CAD), a new study has shown.
Rachel Soon, 01 Sep 2018

MIMS Pharmacist presents an overview of a standardized extract of Pinus pinaster bark, and its potential role in slowing down the progression of diabetic retinopathy.

Dr. Lau Hui Ling, 01 Aug 2017
Oral contraceptive selection should be individualized for each patient to yield maximum benefit.

NSAID use ups risk of major bleeding, stroke in patients with atrial fibrillation

19 Jul 2018

Nonsteroidal anti-inflammatory drugs (NSAIDs) appear to increase the risk of major bleeding, stroke or systemic embolism, and hospitalization among patients with atrial fibrillation (AF), suggest the results of the RE-LY* trial. Moreover, there is no difference in the safety and efficacy of dabigatran etexilate (DE) 150 and 110 mg twice daily relative to warfarin.

A total of 18,113 patients were included in the RE-LY study, of which 2,279 used NSAIDs at least once during the trial. NSAID users had significantly elevated major bleeding (hazard ratio [HR], 1.68; 95 percent CI, 1.40–2.02; p<0.0001). NSAID vs warfarin use did not significantly alter the risk of major bleeding for DE 150 or 110 mg twice daily (p=0.63 and p=0.93 for interaction, respectively).

NSAID use significantly elevated gastrointestinal major bleeding (HR, 1.81; 1.35–2.43; p<0.0001) and the rate of stroke or systemic embolism (HR, 1.50; 1.12–2.01; p=0.007), but it did not significantly alter the relative efficacy on stroke or systemic embolism for DE 150 or 110 mg twice daily relative to warfarin (p=0.59 and p=0.54 for interaction, respectively).

Rates of myocardial infarction were comparable between NSAID use and no NSAID use (HR, 1.22; 0.77–1.93; p=0.40). Furthermore, NSAID use resulted in frequently more hospitalizations (HR, 1.64; 1.51–1.77; p<0.0001).

The authors performed a posthoc analysis of NSAIDs in the RE-LY trial, which compared DE 150 and 110 mg twice daily with warfarin in patients with AF. Clinical outcomes were assessed using treatment-independent, multivariate-adjusted Cox regression analysis by comparing NSAID use with no NSAID use. Interaction analysis was obtained from treatment-dependent Cox regression modelling, and time-varying covariate analysis for NSAID use was applied to the Cox model.

*Randomized Evaluation of Long Term Anticoagulant Therapy

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Most Read Articles
04 Oct 2018
A week of preoperative oral antibiotics prior to percutaneous nephrolithotomy does not appear to confer any benefit in patients at low risk for infectious complications, suggests a recent study. Perioperative antibiotics according to the American Urological Association (AUA) Best Practice Statement is deemed sufficient.
09 Oct 2018
The use of statins does not appear to influence the immature platelet count in patients with coronary artery disease (CAD), a new study has shown.
Rachel Soon, 01 Sep 2018

MIMS Pharmacist presents an overview of a standardized extract of Pinus pinaster bark, and its potential role in slowing down the progression of diabetic retinopathy.

Dr. Lau Hui Ling, 01 Aug 2017
Oral contraceptive selection should be individualized for each patient to yield maximum benefit.