Whenever I’ve seen a cardiac patient with some non-cardiac related pain, I run through the usual analgesic options; simple paracetamol (or acetaminophen for our American friends), NSAIDs, opioids, and other measures. Some pains are ideal to be treated with an NSAID, but I always get a bit concerned about the risks with cardiac disease ever since the whole Vioxx saga – and there was that recent study about the other NSAIDs as well…
This registry based study from Circ looked at over 83,000 patients with a history of MI in the past. NSAIDs were significantly associated with an increased risk of death and recurrent MI ( HR 1.45), and the start of treatment and throughout treatment. Of all the NSAIDs, diclofenac was the worst, with a HR of 3.26. Note that this data does go back to 1997, before rofecoxib was taken off the market.
Looks like if there’s cardiac disease about, you shouldn’t even be thinking about dipping your hand in the NSAID bucket at all. Have a read of this study over here.