Stroke naproxen

Naproxen has been found to increase the risk of heart attack and stroke by 50 percent. 

Aspirin, 325-650 mg every 4-6 hours Bayer Aspirin, Ecotrin, Bufferin, various generic children who cannot chew or swallow tablets. Do not exceed a total daily acetaminophen dose of 4 g (2 g/d in regular alcohol users). Aspirin should be used cautiously in certain individuals (see text). Use of OTC products containing aspirin, other salicylates, acetaminophen, ibuprofen, or naproxen may increase the risk of hepatotoxicity and gastrointestinal hemorrhage in individuals who consume 3 or more alcoholic drinks daily. Long-term continuous use of NSAIDs may increase the risk of heart attack or stroke. 

Information on the effect of COX-2-selective inhibitors on arterial blood pressure is scanty. In VIGOR, more patients developed hypertension with rofecoxib than naproxen. For rofecoxib, the mean increase in blood pressure was 4.6/1.7 mmHg compared with a l.O/O.l mmHg increase with naproxen (34). Previous work has shown that a 2 mmHg reduction in diastolic blood pressure can result in about a 40% reduction in the rate of stroke and a 25% reduction in the rate of myocardial infarction (57). The effect of celecoxib on blood pressure was evaluated in a post hoc analysis... 

Although the studies did demonstrate that Vioxx was safer on the digestive track than Naproxen, they also again unexpectedly found that the COX-2 inhibitor doubled the risk of cardiovascular problems. In April 2002, the FDA required that Merck note a possible link to heart attacks and strokes on Vioxx s label. But it never ordered Merck to conduct a trial comparing Vioxx with a placebo to determine whether a link existed. In April 2000 the FDA recommended that Merck conduct an animal study with Vioxx to evaluate cardiovascular safety, but no such study was ever conducted. 

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... 

In a retrospective cohort study patients with osteoarthritis (6580 patients chronically exposed to celecoxib, 9800 to rofecoxib, 2907 to naproxen, and 51 539 non-chroni-cally exposed controls, either non-chronic users or non-users) were investigated. Comparing the risk of hospitalization for acute myocardial infarction or ischemic stroke with the non-chronic users as the reference group, there was an increased risk with rofecoxib (adjusted HR = 1.25 95% Cl = 1.04, 1.50) but no significantly increased risk with celecoxib or naproxen. Furthermore, the risk of hospitalization for acute myocardial infarction or ischemic stroke varied considerably with patient characteristics the excess risk attributable to rofecoxib... 

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