Cardiovascular adverse effects of NSAIDs

Diclofenac is associated with the highest risk of cardiovascular toxicity and, irrespective of the expected duration of use, should be avoided in patients at high risk of cardiovascular disease.

Short-term use of other NSAIDs (ie for less than 5 days) does not significantly increase the risk of cardiovascular events. Consequently, other NSAIDs should not be withheld in patients with acute pain who have established cardiovascular disease or are at high risk of cardiovascular disease. The exception is postoperative use in patients who have had cardiac surgery—in these patients, NSAIDs should not be used.

Except for diclofenac, all NSAIDs are associated with similar rates of adverse cardiovascular effects when used long term. Patients with chronic pain who are at a high risk of cardiovascular disease should not be prescribed NSAIDs long term because of the increased risk of cardiovascular events.

The protective cardiovascular effects of low-dose aspirin are reduced by concomitant administration of other NSAIDs—for management advice, consult an appropriate drug information resource.