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. 2014;10:25-32.
doi: 10.2147/VHRM.S54159. Epub 2014 Jan 6.

Risk of Stroke Associated With Nonsteroidal Anti-Inflammatory Drugs

Free PMC article

Risk of Stroke Associated With Nonsteroidal Anti-Inflammatory Drugs

Ki Park et al. Vasc Health Risk Manag. .
Free PMC article


Nonsteroidal anti-inflammatory drugs (NSAIDs), both cyclooxygenase (COX)-2-selective and nonselective agents, have been associated with the increased risk of adverse cardiovascular events. The majority of studies have focused on myocardial infarction as the primary cardiovascular outcome. However, the association between NSAIDs and the risk of stroke events is not as clear, although an understanding of this association is important since stroke continues to be a significant cause of morbidity and mortality. Various factors may contribute to an association between NSAIDs and stroke, including hypertension and thrombosis. Additionally, the risk may vary with different NSAID types. In this review, we discuss the relevant literature assessing the possible association between NSAID use and stroke events, along with the potential mechanisms and the possible directions for future study.

Keywords: adverse events; cardiovascular; cyclooxygenase; nonsteroidal anti-inflammatory drugs; stroke.


Figure 1
Figure 1
Effects of COX inhibition on vasculature. Abbreviation: COX, cyclooxygenase.
Figure 2
Figure 2
Relative COX-1/COX-2 selectivity of various nonselective NSAIDs. Note: This chart represents the log (IC50 of COX-1 relative to the IC50 of COX-2) for various nonselective NSAIDs. Adapted with permission Cryer B, Feldman M. Cyclooxygenase-1 and cyclooxygenase-2 selectivity of widely used nonsteroidal anti-inflammatory drugs. Am J Med. 1998;104(5):413–421. © Copyright 1998, with permission Elsevier. Abbreviations: COX, cyclooxygenase; IC50, half maximal inhibitory concentration; NSAID, nonsteroidal anti-inflammatory drug.

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