scholarly journals Trends in prescribing of non-steroidal anti-inflammatory drugs in patients with cardiovascular disease: influence of national guidelines in UK primary care

2018 ◽  
Vol 35 (4) ◽  
pp. 426-432 ◽  
Author(s):  
Ying Chen ◽  
John Bedson ◽  
Richard A Hayward ◽  
Kelvin P Jordan
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
National Guidelines ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Risks of Cardiovascular Disease and Beyond in Prescription of Nonsteroidal Anti-Inflammatory Drugs

2019 ◽  
Vol 25 (1) ◽  
pp. 3-6 ◽  
Author(s):  
Manas A. Rane ◽  
Alexander Gitin ◽  
Benjamin Fiedler ◽  
Lawrence Fiedler ◽  
Charles H. Hennekens
Keyword(s):  
Cardiovascular Disease ◽  
Side Effects ◽  
Health Care Providers ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Care Providers ◽  
Relieve Pain ◽  
Gastrointestinal Side Effects ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) include aspirin, naproxen, diclofenac, and ibuprofen, as well as selective cyclooxygenase 2 inhibitors such as celecoxib. Their use is common, as well as their side effects which cause 100 000 hospitalizations and 17 000 deaths annually. Recently, the US Food and Drug Administration strengthened its warning about the risks of cardiovascular disease (CVD) attributed to nonaspirin NSAIDs. Methods: When the sample size is large, randomization provides control of confounding not possible to achieve with any observational study. Further, observational studies and, especially, claims data have inherent confounding by indication larger than the small to moderate effects being sought. Results: While trials are necessary, they must be of sufficient size and duration and achieve high compliance and follow-up. Until then, clinicians should remain uncertain about benefits and risks of these drugs. Conclusions: Since the totality of evidence remains incomplete, health-care providers should consider all these aforementioned benefits and risks, both CVD and beyond, in deciding whether and, if so, which, NSAID to prescribe. The factors in the decision of whether and, if so, which NSAID to prescribe for relief of pain from inflammatory arthritis should not be limited to risks of CVD or gastrointestinal side effects but should also include potential benefits including improvements in overall quality of life resulting from decreases in pain or impairment from musculoskeletal pain syndromes. The judicious individual clinical decision-making about the prescription of NSAIDs to relieve pain based on all these considerations has the potential to do much more good than harm.

scholarly journals Evidence-Based Recommendations for Short- and Long-Term Management of Uninvestigated Dyspepsia in Primary Care: An Update of the Canadian Dyspepsia Working Group (CanDys) Clinical Management Tool

2005 ◽  
Vol 19 (5) ◽  
pp. 285-303 ◽  
Author(s):  
Sander JO Veldhuyzen van Zanten ◽  
Marc Bradette ◽  
Naoki Chiba ◽  
David Armstrong ◽  
Alan Barkun ◽  
...  
Keyword(s):  
Primary Care ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Clinical Management ◽  
Management Tool ◽  
Noninvasive Testing ◽  
Ulcer Bleeding ◽  
High Dose ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

The present paper is an update to and extension of the previous systematic review on the primary care management of patients with uninvestigated dyspepsia (UD). The original publication of the clinical management tool focused on the initial four- to eight-week assessment of UD. This update is based on new data from systematic reviews and clinical trials relevant to UD. There is now direct clinical evidence supporting a test-and-treat approach in patients with nondominant heartburn dyspepsia symptoms, and head-to-head comparisons show that use of a proton pump inhibitor is superior to the use of H2-receptor antagonists (H2RAs) in the initial treatment of Helicobacter pylori-negative dyspepsia patients. Cisapride is no longer available as a treatment option and evidence for other prokinetic agents is lacking. In patients with long-standing heartburn-dominant (ie, gastroesophageal reflux disease) and nonheartburn-dominant dyspepsia, a once-in-a-lifetime endoscopy is recommended. Endoscopy should also be considered in patients with new-onset dyspepsia that develops after the age of 50 years. Conventional nonsteroidal anti-inflammatory drugs, acetylsalicylic acid and cyclooxygenase-2-selective inhibitors can all cause dyspepsia. If their use cannot be discontinued, cotherapy with either a proton pump inhibitor, misoprostol or high-dose H2RAs is recommended, although the evidence is based on ulcer data and not dyspepsia data. In patients with nonheartburn-dominant dyspepsia, noninvasive testing for H pylori should be performed and treatment given if positive. When starting nonsteroidal anti-inflammatory drugs for a prolonged course, testing and treatment with H2RAs are advised if patients have a history of previous ulcers or ulcer bleeding.

The prescribing of analgesics and non-steroidal anti-inflammatory drugs in paediatric primary care in the UK, Italy and the Netherlands

2010 ◽  
Vol 62 (3) ◽  
pp. 243-248 ◽  
Author(s):  
Antje Neubert ◽  
Katia Verhamme ◽  
Macey L. Murray ◽  
Gino Picelli ◽  
Yingfen Hsia ◽  
...  
Keyword(s):  
Primary Care ◽  
The Netherlands ◽  
Paediatric Primary Care ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
The Uk

Use of Nonsteroidal Anti-Inflammatory Drugs in Patients With Cardiovascular Disease

2010 ◽  
Vol 18 (4) ◽  
pp. 204-212 ◽  
Author(s):  
Muhammad Amer ◽  
Valeriani R. Bead ◽  
Joan Bathon ◽  
Roger S. Blumenthal ◽  
David N. Edwards
Keyword(s):  
Cardiovascular Disease ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

COX-2 selective non-steroidal anti-inflammatory drugs and cardiovascular disease

2003 ◽  
Vol 12 (1) ◽  
pp. 67-70 ◽  
Author(s):  
Wayne A. Ray ◽  
Thomas M. MacDonald ◽  
Daniel H. Solomon ◽  
David J. Graham ◽  
Jerry Avorn
Keyword(s):  
Cardiovascular Disease ◽  
Inflammatory Drugs ◽  
Cox 2 ◽  
Anti Inflammatory
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