Nonsteroidal anti-inflammatory drugs linked to haemorrhagic stroke in meta-analysis

Takeaway

• Use of nonsteroidal anti-inflammatory drugs (NSAIDs) showed significant association with higher risk of developing haemorrhagic stroke.
• In subgroup analysis, ketorolac, meloxicam, naproxen, diclofenac, and indomethacin increased the risk for haemorrhagic stroke.

Why this matters

• NSAIDs are considered safe, are often available over-the-counter in pharmacies and usually taken without the advice of physicians/pharmacists.
• Findings suggest NSAIDs should be used judiciously and monitored proactively.

Study design

• Meta-analysis of 13 studies including 1,839,462 participants identified after a search on PubMed, EMBASE, Scopus and Web of Science between January 1990 and July 2017.
• Funding: TMU Research Centre of Cancer Translational Medicine.

Key results

• NSAIDs use was significantly associated with higher risk for haemorrhagic stroke vs nonusers (pooled RR, 1.332; 95% CI, 1.105-1.605).
• Risk for haemorrhagic stroke was higher in studies from
  • Asia: RR, 1.490 (95% CI, 1.226-1.811);
  • Europe: RR, 1.393 (95% CI, 1.104-1.757) and
  • Australia: RR, 1.361 (95% CI, 0.755-2.452).
• Significant risk for haemorrhagic stroke was higher with the use of
  • ketorolac: RR, 2.722 (95% CI, 1.047-7.078);
  • meloxicam: RR, 1.482 (95% CI, 1.149-1.912);
  • naproxen: RR, 1.486 (95% CI, 1.014-2.178);
  • diclofenac: RR, 1.392 (95% CI, 1.107-1.751) and
  • indomethacin: RR, 1.363 (95% CI, 1.088-1.706).

Limitations

• Heterogeneity between studies.