Nonaspirin Nonsteroidal Anti-Inflammatory Drugs and Risk of Hemorrhagic Stroke

A Systematic Review and Meta-Analysis of Observational Studies

Patompong Ungprasert, Eric Lawrence Matteson, Charat Thongprayoon

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE—: The association between hemorrhagic stroke and use of nonsteroidal anti-inflammatory drugs (NSAIDs) is not well established. We conducted a systematic review and meta-analysis of observation studies to further characterize this possible association. METHODS—: Case–control and cohort studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing risk of hemorrhagic stroke among NSAIDs users versus nonusers were systematically searched. Point estimates from each study were extracted. Pooled risk ratios (RR) and 95% confidence intervals (CI) for all NSAIDs and individual NSAIDs were calculated using random-effect, generic inverse variance method. RESULTS—: Ten studies were identified and included in our data analysis. As a single group, NSAIDs use was associated with a small but insignificant risk of hemorrhagic stroke with the pooled RR of 1.09 (95% CI, 0.98–1.22). Individual NSAIDs analysis revealed a significantly increased risk among diclofenac and meloxicam users (RR 1.27; 95% CI, 1.02–1.59 and RR 1.27; 95% CI, 1.08–1.50, respectively). The risk estimate for rofecoxib users was higher, but statistically nonsignificant (RR 1.35; 95% CI, 0.88–2.06). CONCLUSIONS—: Overall, the use of NSAIDs is not associated with an increased risk of hemorrhagic stroke, although this risk was modestly significantly elevated in diclofenac and meloxicam users.

Original languageEnglish (US)
JournalStroke
DOIs
StateAccepted/In press - Dec 15 2015

Fingerprint

Observational Studies
Meta-Analysis
Anti-Inflammatory Agents
Stroke
Odds Ratio
meloxicam
Pharmaceutical Preparations
Confidence Intervals
Diclofenac
Drug Users
Cohort Studies
Observation
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Nonaspirin Nonsteroidal Anti-Inflammatory Drugs and Risk of Hemorrhagic Stroke : A Systematic Review and Meta-Analysis of Observational Studies. / Ungprasert, Patompong; Matteson, Eric Lawrence; Thongprayoon, Charat.

In: Stroke, 15.12.2015.

Research output: Contribution to journalArticle

@article{ad8a69b120ec41f7811d54bb19a5c351,
title = "Nonaspirin Nonsteroidal Anti-Inflammatory Drugs and Risk of Hemorrhagic Stroke: A Systematic Review and Meta-Analysis of Observational Studies",
abstract = "BACKGROUND AND PURPOSE—: The association between hemorrhagic stroke and use of nonsteroidal anti-inflammatory drugs (NSAIDs) is not well established. We conducted a systematic review and meta-analysis of observation studies to further characterize this possible association. METHODS—: Case–control and cohort studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing risk of hemorrhagic stroke among NSAIDs users versus nonusers were systematically searched. Point estimates from each study were extracted. Pooled risk ratios (RR) and 95{\%} confidence intervals (CI) for all NSAIDs and individual NSAIDs were calculated using random-effect, generic inverse variance method. RESULTS—: Ten studies were identified and included in our data analysis. As a single group, NSAIDs use was associated with a small but insignificant risk of hemorrhagic stroke with the pooled RR of 1.09 (95{\%} CI, 0.98–1.22). Individual NSAIDs analysis revealed a significantly increased risk among diclofenac and meloxicam users (RR 1.27; 95{\%} CI, 1.02–1.59 and RR 1.27; 95{\%} CI, 1.08–1.50, respectively). The risk estimate for rofecoxib users was higher, but statistically nonsignificant (RR 1.35; 95{\%} CI, 0.88–2.06). CONCLUSIONS—: Overall, the use of NSAIDs is not associated with an increased risk of hemorrhagic stroke, although this risk was modestly significantly elevated in diclofenac and meloxicam users.",
author = "Patompong Ungprasert and Matteson, {Eric Lawrence} and Charat Thongprayoon",
year = "2015",
month = "12",
day = "15",
doi = "10.1161/STROKEAHA.115.011678",
language = "English (US)",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Nonaspirin Nonsteroidal Anti-Inflammatory Drugs and Risk of Hemorrhagic Stroke

T2 - A Systematic Review and Meta-Analysis of Observational Studies

AU - Ungprasert, Patompong

AU - Matteson, Eric Lawrence

AU - Thongprayoon, Charat

PY - 2015/12/15

Y1 - 2015/12/15

N2 - BACKGROUND AND PURPOSE—: The association between hemorrhagic stroke and use of nonsteroidal anti-inflammatory drugs (NSAIDs) is not well established. We conducted a systematic review and meta-analysis of observation studies to further characterize this possible association. METHODS—: Case–control and cohort studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing risk of hemorrhagic stroke among NSAIDs users versus nonusers were systematically searched. Point estimates from each study were extracted. Pooled risk ratios (RR) and 95% confidence intervals (CI) for all NSAIDs and individual NSAIDs were calculated using random-effect, generic inverse variance method. RESULTS—: Ten studies were identified and included in our data analysis. As a single group, NSAIDs use was associated with a small but insignificant risk of hemorrhagic stroke with the pooled RR of 1.09 (95% CI, 0.98–1.22). Individual NSAIDs analysis revealed a significantly increased risk among diclofenac and meloxicam users (RR 1.27; 95% CI, 1.02–1.59 and RR 1.27; 95% CI, 1.08–1.50, respectively). The risk estimate for rofecoxib users was higher, but statistically nonsignificant (RR 1.35; 95% CI, 0.88–2.06). CONCLUSIONS—: Overall, the use of NSAIDs is not associated with an increased risk of hemorrhagic stroke, although this risk was modestly significantly elevated in diclofenac and meloxicam users.

AB - BACKGROUND AND PURPOSE—: The association between hemorrhagic stroke and use of nonsteroidal anti-inflammatory drugs (NSAIDs) is not well established. We conducted a systematic review and meta-analysis of observation studies to further characterize this possible association. METHODS—: Case–control and cohort studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing risk of hemorrhagic stroke among NSAIDs users versus nonusers were systematically searched. Point estimates from each study were extracted. Pooled risk ratios (RR) and 95% confidence intervals (CI) for all NSAIDs and individual NSAIDs were calculated using random-effect, generic inverse variance method. RESULTS—: Ten studies were identified and included in our data analysis. As a single group, NSAIDs use was associated with a small but insignificant risk of hemorrhagic stroke with the pooled RR of 1.09 (95% CI, 0.98–1.22). Individual NSAIDs analysis revealed a significantly increased risk among diclofenac and meloxicam users (RR 1.27; 95% CI, 1.02–1.59 and RR 1.27; 95% CI, 1.08–1.50, respectively). The risk estimate for rofecoxib users was higher, but statistically nonsignificant (RR 1.35; 95% CI, 0.88–2.06). CONCLUSIONS—: Overall, the use of NSAIDs is not associated with an increased risk of hemorrhagic stroke, although this risk was modestly significantly elevated in diclofenac and meloxicam users.

UR - http://www.scopus.com/inward/record.url?scp=84950150135&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84950150135&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.115.011678

DO - 10.1161/STROKEAHA.115.011678

M3 - Article

JO - Stroke

JF - Stroke

SN - 0039-2499

ER -