Recommendations for NSAID use in Patients with CVD
Disease
Recommendation
CAD
Avoid NSAIDs because of dose-related increase in MACE, even when used for short durations
If NSAIDs are medically necessary, educate patients about risks
Nonselective NSAIDs are preferable
Use ibuprofen only as needed in patients receiving aspirin for secondary prevention
Take ibuprofen at least 30 minutes after immediate-release aspirin or more than eight hours prior to aspirin
Heart failure
Avoid NSAIDs when possible
Celecoxib may be safer
Low-dose aspirin likely safe when indicated (eg, prior MI)
Educate patients taking nonprescription NSAIDs to use lowest doses and shortest durations possible and consult healthcare provider for significant changes in body weight to reduce decompensation risk
Hypertension
Patients at risk for developing hypertension should be monitored for changes in BP with NSAIDs, although infrequent as-needed use is likely acceptable
NSAID use should be evaluated concurrently with other lifestyle changes
In preexisting hypertension, NSAIDS should be avoided
In hypertensive patients taking NSAIDs, adjustments in hypertensive therapy and closer monitoring may be required
Atrial fibrillation
Insufficient evidence to make recommendations
Use caution in patients at high risk
Upper gastrointestinal bleeding
Patients at risk for UGIB should avoid NSAIDs
Nonprescription NSAIDs should be used at lowest dose and shortest duration
Ibuprofen, celecoxib and potentially diclofenac appear to have lowest risk