Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Pharmacoepidemiol Drug Saf. 2011 Jun;20(6):635-42. doi: 10.1002/pds.2130.
Non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with an increased risk of arterial thrombosis, but their effect on venous thrombotic events is less well established. The study aimed to assess the risk of symptomatic pulmonary embolism (PE) in patients using NSAIDs and to evaluate any effect of type, dose, and duration of therapy.
A case-control study was conducted using the PHARMO Record Linkage System, a Dutch population-based registry. Cases were patients hospitalized with a primary diagnosis of PE and were matched to controls without a history of PE. To exclude confounding by indication, the effect of painkillers without known hemostatic effects was assessed.
The study population consisted of 4433 cases and 16,802 controls. After adjustment for surgery, trauma, and malignancy, current use of NSAIDs was associated with PE (odds ratio (OR) 2.39, 95% confidence interval (CI) 2.06-2.77). The risk was highest for traditional NSAIDs, and the overall risk for NSAIDs was highest in the first 30 days of exposure (OR 4.77, 95%CI 3.92-5.81), as compared with chronic (<1 year; OR 1.83, 95%CI 1.47-2.28) or long-term use (>1 year; OR 2.14, 95%CI 1.48-3.09). Use of acetaminophen and tramadol also increased the risk of PE (OR 1.74, 95%CI 1.42-2.14 and OR 4.07, 95%CI 2.86-5.75, respectively) with a similar time trend.
Use of NSAIDs is associated with an increased risk of symptomatic PE. This association may be partially explained by underlying medical conditions, as suggested by a similarly increased thrombotic risk in patients receiving acetaminophen and tramadol.
非甾体抗炎药（NSAIDs）与动脉血栓形成的风险增加有关，但它们对静脉血栓栓塞事件的影响尚不清楚。本研究旨在评估使用 NSAIDs 的患者发生症状性肺栓塞（PE）的风险，并评估治疗类型、剂量和持续时间的任何影响。
使用 PHARMO 记录链接系统进行了病例对照研究，这是一个荷兰基于人群的登记处。病例为因原发性 PE 住院的患者，并与无 PE 病史的对照匹配。为了排除指示性混杂因素，评估了无已知止血作用的止痛药的影响。
研究人群包括 4433 例病例和 16802 例对照。在调整手术、创伤和恶性肿瘤后，当前使用 NSAIDs 与 PE 相关（比值比（OR）2.39，95%置信区间（CI）2.06-2.77）。传统 NSAIDs 的风险最高，在暴露的前 30 天内 NSAIDs 的总体风险最高（OR 4.77，95%CI 3.92-5.81），与慢性（<1 年；OR 1.83，95%CI 1.47-2.28）或长期使用（>1 年；OR 2.14，95%CI 1.48-3.09）相比。使用对乙酰氨基酚和曲马多也会增加 PE 的风险（OR 1.74，95%CI 1.42-2.14 和 OR 4.07，95%CI 2.86-5.75），具有相似的时间趋势。
使用 NSAIDs 与症状性 PE 的风险增加相关。这种关联可能部分解释为接受对乙酰氨基酚和曲马多治疗的患者的血栓形成风险相似增加，表明这可能是由潜在的医疗条件引起的。
