Stroke diclofenac

Meloxicam demonstrates some COX-2 selectivity, but a clinical advantage or hazjard has yet to be established. There is significantly less gastric injury compared to piroxicam (20 mg/day) in subjects treated with 7.5 mg/day of meloxicam, but the advantage is lost with 15 mg/day. Like diclofenac, meloxicam does not offer a desirable cdterrmtive to prescribing celecoxib to patients at increased risk of myocardial infarction or stroke. 

FP has a history of cardiovascular disease, having survived a myocardial infarction that occurred in his mid-50s and, more recently, a stroke. Currently, he is on extended-release diltiazem (Cardiazem, 420 mg q.i.d.) and betaxolol HCI (Kerlone, 10 mg q.i.d.) for chronic stable angina coupled with hypertension. He also takes one baby aspirin each day. FP is troubled by rheumatoid arthritis, for which he takes diclofenac (Voltaren, 50 mg t.i.d.), and he has a documented allergy to sulfonamides. 

Serious and potentially fatal cardiovascular (CV) thrombotic events, myocardial infarction, and stroke can occur with NSAID treatment. Diclofenac should be used with caution in patients with known CV disease or risk factors for CV disease. 

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