Salvo Francesco, Antoniazzi Stefania, Duong Mai, Molimard Mathieu, Bazin Fabienne, Fourrier-Réglat Annie, Pariente Antoine, Moore Nicholas
University of Bordeaux, Pharmacology , 146 rue Leo Saignat, 33076 Bordeaux , France +33 557574671 ; +33 557574671 ;
Expert Opin Drug Saf. 2014 May;13(5):573-85. doi: 10.1517/14740338.2014.907792. Epub 2014 Apr 3.
An increased risk of cardiovascular thrombotic events in users of NSAIDs was first demonstrated for rofecoxib. This risk seems to be related to the COX-2 inhibitory potency and has been found with most NSAIDs except naproxen. Two main hypotheses have been advanced: an imbalance between COX-1-dependent platelet production of thromboxane and partly COX-2-dependent endothelial production of prostacyclin, and a COX-2-dependent increase in blood pressure.
Clinical trials and observational studies providing information about cardiovascular risk associated with long-term use of NSAIDs were retrieved; 14 clinical trials and 16 observational studies mentioned a follow-up of at least 6 months.
Results are ambiguous: long-term exposure seemed associated with an increased risk of myocardial infarction or stroke with high-dose rofecoxib, and perhaps diclofenac, but less with other NSAIDs. In other studies, little or no increase in risk was associated with exposures shorter than 30 days. Since most NSAIDs are rarely used long term, there is little information on risks associated with long-term use. The relative risks or odds ratios associated with most drugs are mostly well below 2.
非甾体抗炎药（NSAIDs）使用者心血管血栓形成事件风险增加首先在罗非昔布中得到证实。这种风险似乎与COX-2抑制效力有关，并且除萘普生外，在大多数NSAIDs中均已发现。已经提出了两个主要假设：COX-1依赖性血小板生成血栓素与部分COX-2依赖性内皮细胞生成前列环素之间的失衡，以及COX-2依赖性血压升高。
检索了提供有关长期使用NSAIDs相关心血管风险信息的临床试验和观察性研究；14项临床试验和16项观察性研究提到了至少6个月的随访。
结果不明确：长期暴露似乎与高剂量罗非昔布以及可能与双氯芬酸导致的心肌梗死或中风风险增加有关，但与其他NSAIDs的相关性较小。在其他研究中，暴露时间短于30天与风险增加很少或没有关联。由于大多数NSAIDs很少长期使用，因此关于长期使用相关风险的信息很少。与大多数药物相关的相对风险或比值比大多远低于2。
