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Paracetamol, Ibuprofen, and Recurrent Major Cardiovascular and Major Bleeding Events in 19 120 Patients With Recent Ischemic Stroke
- Source :
- Stroke. 47(4)
- Publication Year :
- 2015
-
Abstract
- Background and Purpose— The presumed safety of paracetamol in high–cardiovascular risk patients has been questioned. We determined whether paracetamol or ibuprofen use is associated with major cardiovascular events (MACE) or major bleeding in 19 120 patients with recent ischemic stroke or transient ischemic attack of mainly atherothrombotic origin included in the Prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) trial. Methods— We performed 2 nested case–control analysis (2153 cases with MACE during trial follow-up and 4306 controls matched on Essen stroke risk score; 809 cases with major bleeding matched with 1616 controls) and a separate time-varying analysis. Results— 12.3% were prescribed paracetamol and 2.5% ibuprofen. Median duration of treatment was 14 (interquartile range 5–145) days for paracetamol and 9 (5–30) days for ibuprofen. Paracetamol, but not ibuprofen, was associated with increased risk of MACE (odds ratio 1.21, 95% confidence interval [CI] 1.04–1.42) or a major bleeding (odds ratio 1.60, 95% CI 1.26–2.03), with no impact of daily dose and duration of paracetamol treatment. Time-varying analysis found an increased risk of MACE with both paracetamol (hazard ratio 1.22, 95% CI 1.05–1.43) and ibuprofen (hazard ratio 1.47, 95% CI 1.06–2.03) and of major bleeding with paracetamol (hazard ratio 1.95, 95% CI 1.45–2.62). Conclusions— There was a weak and inconsistent signal for association between paracetamol or ibuprofen and MACE or major bleeding, which may be related to either a genuine but modest effect of these drugs or to residual confounding. Clinical Trial Registration— http://www.isrctn.com . Unique identifier: ISRCTN66157730.
- Subjects :
- Male
medicine.medical_specialty
PERFORM Investigators
Hemorrhage
Ibuprofen
030204 cardiovascular system & hematology
1102 Cardiovascular Medicine And Haematology
Brain Ischemia
Brain ischemia
cardiovascular events
03 medical and health sciences
0302 clinical medicine
Interquartile range
Recurrence
Risk Factors
Internal medicine
medicine
Humans
030212 general & internal medicine
610 Medicine & health
Stroke
Acetaminophen
Aged
Advanced and Specialized Nursing
Neurology & Neurosurgery
business.industry
organic chemicals
1103 Clinical Sciences
Analgesics, Non-Narcotic
Middle Aged
antiplatelet agent
bleeding
medicine.disease
Terutroban
Cardiovascular Diseases
transient ischemic attack
Anesthesia
Female
Neurology (clinical)
1109 Neurosciences
Cardiology and Cardiovascular Medicine
business
Major bleeding
Mace
medicine.drug
Subjects
Details
- ISSN :
- 15244628, 66157730, and 00392499
- Volume :
- 47
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Stroke
- Accession number :
- edsair.doi.dedup.....198becc352b45b1602b3df34e15dfc4c