Myocardial infarction ibuprofen

Another vasoactive substance produced by the endothelium is thromboxane A2 (TxA2). Normally, small amounts of TxA2 are released continuously however, increased synthesis appears to be associated with some cardiac diseases. Synthesized from arachidonic acid, a plasma membrane phospholipid, TxA2 is a potent vasoconstrictor. Furthermore, this substance stimulates platelet aggregation, suggesting that it plays a role in thrombotic events such as myocardial infarction (heart attack). Nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen block formation of TxA2 and reduce formation of blood clots. 

In VIGOR, rofecoxib 50 mg/day was associated with a higher rate of non-fatal myocardial infarction (0.4%) than the non-selective COX-2 inhibitor naproxen 500 mg bd (0.1%) (RR = 0.2 Cl = 0.1, 0.7) (33). In CLASS there was no difference in the rates of myocardial infarction in patients taking celecoxib (0.5%) and those taking ibuprofen or diclofenac (0.4%). However, the protocols of the two studies differed substantially with respect to the use of aspirin. In VIGOR, the patients were not allowed to take aspirin or any other antiplatelet drug, while in... 

Curtis JP, Wang Y, Portnay EL, Masoudi FA, Havranek EP, Krumholz HM. Aspirin, ibuprofen, and mortality after myocardial infarction retrospective cohort study. BMJ (2003) 327, 1322-3. 

Patel TN,Goldberg KC. Use of aspirin and ibuprofen compared with aspirin alone and the risk of myocardial infarction. Arch Intern Med (2004) 164, 852-6. 

Patients with osteoarthritis or rheumatoid arthritis are randomized to one of three treatments, celecoxib, ibuprofen, or naproxen, and the primary endpoint is the occurrence of a cardiovascular endpoint a nonfatal myocardial infarction, a nonfatal stroke, or any cardiovascular death. Non-inferiority will be assessed for three different pairwise comparisons celecoxib versus ibuprofen, celecoxib versus naproxen, and ibuprofen versus naproxen. The definition of non-inferiority differs somewhat from the fixed margin approach describe earlier in that there are separate criteria for the confidence interval and the point estimate. The hazard ratio for each comparison will be calculated, and non-inferiority will be concluded if the upper end of the... 

NSAIDs, including ibuprofen, are contraindicated in patients with active bleeding, ulceration, or perforated viscous. NSAIDs are contraindicated in the setting of acute or chronic renal dysfunction. NSAIDs have been shown to increase the risk of cardiovascular thrombotic events, myocardial infarction, and stroke, especially in patients with known cardiovascular disease or with known risk factors for cardiovascular... 

Injectable ibuprofen is contraindicated in the peri-operative period in patients imdergoing coronary artery bypass graft (CABG) simgery secondary to an increased risk of thrombotic events and myocardial infarction. 

In a case-control study using drug-dispensing and hospitalization data from more than 2 million residents in The Netherlands, subjects with a first hospitalization for acute myocardial infarction, cardiovascular and gastrointestinal events were identified [14 J. Use of coxibs and non-selective NSAIDs was classified into remote, recent, and current use. Compared with remote use, the risk of acute myocardial infarction was increased in current users of all coxibs (adjusted OR = 1.73 95% Cl = 1.37, 2.19) and all non-selective NSAIDs (adjusted OR = 1.41 95% Cl = 1.23, 1.61). Analysis by separate agents showed that the risk of acute myocardial infarction was increased with celecoxib (OR = 2.53 95% Cl = 1.53, 4.18), rofecoxib (OR = 1.60 95% Cl = 1.22, 2.10), ibuprofen (OR = 1.56 95% Cl — 1.19, 2.05), and diclofenac (OR = 1.51 95% Cl = 1.22, 1.87), but not with naproxen (OR = 1.21 95% Cl = 0.87,1.68). 

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